Evaluation and Management of the Adolescent Varicocele
2015; Lippincott Williams & Wilkins; Volume: 194; Issue: 5 Linguagem: Inglês
10.1016/j.juro.2015.06.079
ISSN1527-3792
Autores Tópico(s)Sexual Differentiation and Disorders
ResumoNo AccessJournal of UrologyReview Article1 Nov 2015Evaluation and Management of the Adolescent Varicocele Thomas F. Kolon Thomas F. KolonThomas F. Kolon View All Author Informationhttps://doi.org/10.1016/j.juro.2015.06.079AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Varicocele is one of the most common genital conditions referred to pediatric urologists. Most adolescents with varicocele are asymptomatic and their fertility future (and surgery benefit) is largely unknown. This review assesses varicocele evaluation, management and indications for repair, as well as types and success of varicocelectomy. Materials and Methods: A systematic literature review was performed on Embase™, PubMed® and Google Scholar™ for adolescent varicocele. Original research articles and relevant reviews were examined, and a synopsis of these data was generated for a comprehensive review of clinical adolescent varicocele management. Results: The prevalence of adolescent varicocele is similar to the adult population. While ultrasound is the most sensitive method for determining testicular volumes, orchidometer measurement may be adequate to gauge significant discordance. Significant hypotrophy of the affected testis with poor total testicular volume may indicate a testis at risk and warrant surgical repair. Similar findings have been noted with an associated high peak retrograde venous flow. Testicular hypotrophy often resolves following surgery but may also improve spontaneously if followed through adolescence. Continued scrotal pain despite adequate support or serial abnormal semen analysis in Tanner stage V boys is an indication for varicocelectomy. Artery and lymphatic sparing techniques (microscopic subinguinal or laparoscopic) are associated with the lowest risk of recurrence and complications. Conclusions: Overtreatment and under treatment are medically and financially costly. Abnormal serial semen analysis with or without testicular hypotrophy is an indication for varicocele repair. If observation remains the treatment, followup with an adult urologist should be encouraged until paternity is achieved. References 1 : The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. BJU Int2000; 86: 490. Google Scholar 2 : The adolescent varicocele: what's new with an old problem in young patients?. Pediatrics1997; 100: 112. Crossref, Medline, Google Scholar 3 : Varicocele in adolescence induces left and right testicular volume loss. BJU Int2001; 87: 499. Google Scholar 4 : Testicular hypotrophy does not correlate with grade of adolescent varicocele. J Urol2005; 174: 2367. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byNiederberger C (2018) Re: Introduction: Varicoceles: A Contemporary PerspectiveJournal of Urology, VOL. 199, NO. 6, (1381-1383), Online publication date: 1-Jun-2018.Çayan S, Şahin S and Akbay E (2017) Paternity Rates and Time to Conception in Adolescents with Varicocele Undergoing Microsurgical Varicocele Repair vs Observation Only: A Single Institution Experience with 408 PatientsJournal of Urology, VOL. 198, NO. 1, (195-201), Online publication date: 1-Jul-2017.Faasse M (2015) Re: Semen Parameters in Adolescents with Varicocele: Association with Testis Volume Differential and Total Testis VolumeJournal of Urology, VOL. 195, NO. 2, (527-528), Online publication date: 1-Feb-2016. Volume 194Issue 5November 2015Page: 1194-1201 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsadolescenttestissemen analysisvaricoceleinfertilityMetricsAuthor Information Thomas F. Kolon More articles by this author Expand All Advertisement PDF downloadLoading ...
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