MICROSURGICAL REPAIR OF THE ADOLESCENT VARICOCELE
1998; Lippincott Williams & Wilkins; Volume: 160; Issue: 1 Linguagem: Inglês
10.1016/s0022-5347(01)63086-6
ISSN1527-3792
AutoresGary E. Lemack, Robert G. Uzzo, Peter N. Schlegel, MARC GOLDSTEIN,
Tópico(s)Sexual Differentiation and Disorders
ResumoNo AccessJournal of UrologyPediatric Urology1 Jul 1998MICROSURGICAL REPAIR OF THE ADOLESCENT VARICOCELE GARY E. LEMACK, ROBERT G. UZZO, PETER N. SCHLEGEL, and MARC GOLDSTEIN GARY E. LEMACKGARY E. LEMACK , ROBERT G. UZZOROBERT G. UZZO , PETER N. SCHLEGELPETER N. SCHLEGEL , and MARC GOLDSTEINMARC GOLDSTEIN View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63086-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Since clinically apparent varicoceles may affect testicular volume and sperm production, early repair has been advocated. However, repair of the pediatric varicocele with conventional nonmagnified techniques may result in persistence of the varicocele after up to 16% of these procedures. Also testicular artery injury and postoperative hydrocele formation can occur after nonmagnified repair. The microsurgical technique has been successfully completed in a large series of adults with a dramatic reduction in complication and recurrence rates. We report our experience with the microsurgical technique in boys. Materials and Methods: A total of 30 boys (average age 15.9 years) underwent 42 microsurgical varicocelectomies (12 bilateral). All patients had a large left varicocele. Indications for repair included testicular atrophy (size difference between testicles of greater than 2 ml.) in 20 boys, pain in 5 and a large varicocele without pain or testicular atrophy in 5. Six boys were referred following failure of conventional nonmicrosurgical techniques. All boys were examined no sooner than 1 month postoperatively (mean followup 12). Results: Preoperative volume of the affected testis averaged 13.0 ml., and an average size discrepancy between testicles of 2.8 ml. was noted before unilateral varicocelectomy. No cases of persistent or recurrent varicoceles were detected, and 1 postoperative hydrocele resolved spontaneously. After unilateral varicocelectomy the treated testes grew an average of 50.1%, while the contralateral testes grew only 23%. Overall, 89% of patients with testicular atrophy demonstrated reversal of testicular growth retardation after unilateral varicocelectomy. In contrast, both testes showed similar growth rates after bilateral varicocelectomy (45% left testis, 39% right testis). Conclusions: The meticulous dissection necessary to preserve arterial and lymphatic supply, and to ligate all spermatic veins in the pediatric patient is readily accomplished using a microsurgical approach, and results in low recurrence and complication rates. Rapid catch-up growth of the affected testis after microsurgical varicocelectomy suggests that intervention during adolescence is effective and warranted. References 1 : Varicocele in children and adolescents. An investigation of the incidence among Danish school children.. Scand. J. Urol. Nephrol.1971; 5: 27. Google Scholar 2 : The relationship of biopsy evaluations and testicular measurements to over-all daily sperm production in human testes.. Fertil. Steril.1980; 34: 36. Google Scholar 3 : Pituitary gonadal dysfunction in adolescents with varicocele.. Urology1993; 42: 179. Google Scholar 4 : Relationship between varicocele size and response to varicocelectomy.. J. Urol.1993; 149: 769. Abstract, Google Scholar 5 : Reversal of testicular growth failure by varicocele ligation.. J. Urol.1987; 137: 475. Abstract, Google Scholar 6 : Varicocele in children: “to treat or not to treat”-venographic and manometric studies.. J. Ped. Surg.1986; 21: 1046. Google Scholar 7 : Testicular growth after successful varicocele correction in adolescence: comparison of artery sparing techniques with the Palomo procedure.. J. Urol.1995; 153: 482. Abstract, Google Scholar 8 : Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data.. J. Urol.1994; 152: 1127. Abstract, Google Scholar 9 : Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique.. J. Urol.1992; 148: 1808. Abstract, Google Scholar 10 : Surgical management of male infertility and other scrotal disorders.. In: Campbell's Urology. Edited by . Philadelphia: W. B. Saunders1998: 1331. chapy. 44. Google Scholar 11 : Varicocele in childhood and adolescence: implication in adulthood infertility?. Urology1982; 19: 641. Google Scholar 12 : Progressive testicular atrophy in the varicocele patient.. J. Urol.1977; 117: 175. Abstract, Google Scholar 13 : Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles.. J. Urol.1997; 158: 605. Abstract, Google Scholar 14 : Inguinal microsurgical varicocelectomy in the adolescent: technique and preliminary results. J. Urol.1998; 159: 1022. Link, Google Scholar James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center and Population Council, Center for Biomedical Research, Rockefeller University, New York, New YorkRead at annual meeting of American Urological Association, New Orleans, Louisiana, April 12-17, 1997.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byÇayan S, Şahin S and Akbay E (2018) 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.Wong J, Chan S, Pagala M and Friedman S (2018) Lymphatic Sparing Microscopic Retroperitoneal Varicocelectomy: A Preliminary ExperienceJournal of Urology, VOL. 182, NO. 5, (2460-2463), Online publication date: 1-Nov-2009.Lebed B, Packer M, Husmann D and Zaontz M (2008) Results and Complications of Adolescent Varicocele Repair With Intraoperative Sodium Morrhuate SclerotherapyJournal of Urology, VOL. 180, NO. 4S, (1837-1841), Online publication date: 1-Oct-2008.Hassan J, Adams M, Pope J, Demarco R and Brock J (2018) Hydrocele Formation Following Laparoscopic VaricocelectomyJournal of Urology, VOL. 175, NO. 3, (1076-1079), Online publication date: 1-Mar-2006.Schwentner C, Oswald J, Lunacek A, Deibl M, Bartsch G and Radmayr C (2018) Optimizing the Outcome of Microsurgical Subinguinal Varicocelectomy Using Isosulfan Blue: A Prospective Randomized TrialJournal of Urology, VOL. 175, NO. 3, (1049-1052), Online publication date: 1-Mar-2006.ÇAYAN S, ACAR D, ÜLGER S and AKBAY E (2018) ADOLESCENT VARICOCELE REPAIR: LONG-TERM RESULTS AND COMPARISON OF SURGICAL TECHNIQUES ACCORDING TO OPTICAL MAGNIFICATION USE IN 100 CASES AT A SINGLE UNIVERSITY HOSPITALJournal of Urology, VOL. 174, NO. 5, (2003-2007), Online publication date: 1-Nov-2005.Greenfield S, Seville P and Wan J (2018) Experience with Varicoceles in Children and Young AdultsJournal of Urology, VOL. 168, NO. 4 Part 2, (1684-1688), Online publication date: 1-Oct-2002.Çayan S, Akbay E, Bozlu M, Doruk E, Erdem E, Acar D and Ulusoy E (2018) The Effect of Varicocele Repair on Testicular Volume in Children And Adolescents With VaricoceleJournal of Urology, VOL. 168, NO. 2, (731-734), Online publication date: 1-Aug-2002.MAZZONI G, SPAGNOLI A, LUCCHETTI M, VILLA M, CAPITANUCCI M and FERRO F (2018) ADOLESCENT VARICOCELE: TAUBER ANTEGRADE SCLEROTHERAPY VERSUS PALOMO REPAIRJournal of Urology, VOL. 166, NO. 4, (1462-1464), Online publication date: 1-Oct-2001. Volume 160Issue 1July 1998Page: 179-181 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information GARY E. LEMACK More articles by this author ROBERT G. UZZO More articles by this author PETER N. SCHLEGEL More articles by this author MARC GOLDSTEIN More articles by this author Expand All Advertisement PDF downloadLoading ...
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