Incidence, Significance and Natural History of Persistent Retrograde Venous Flow After Varicocelectomy in Children and Adolescents: Correlation with Catch-up Growth
2013; Lippincott Williams & Wilkins; Volume: 190; Issue: 2 Linguagem: Inglês
10.1016/j.juro.2013.02.3195
ISSN1527-3792
AutoresJason Van Batavia, Angela M. Fast, Shannon N. Nees, Miguel Ángel Mercado, Anthony Gaselberti, Kenneth I. Glassberg,
Tópico(s)Urologic and reproductive health conditions
ResumoNo AccessJournal of UrologyPediatric Urology1 Aug 2013Incidence, Significance and Natural History of Persistent Retrograde Venous Flow After Varicocelectomy in Children and Adolescents: Correlation with Catch-up Growth Jason P. Van Batavia, Angela M. Fast, Shannon N. Nees, Miguel A. Mercado, Anthony Gaselberti, and Kenneth I. Glassberg Jason P. Van BataviaJason P. Van Batavia More articles by this author , Angela M. FastAngela M. Fast More articles by this author , Shannon N. NeesShannon N. Nees More articles by this author , Miguel A. MercadoMiguel A. Mercado Current address: Department of Urology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030. More articles by this author , Anthony GaselbertiAnthony Gaselberti More articles by this author , and Kenneth I. GlassbergKenneth I. Glassberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3195AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Varying incidences and levels of persistent retrograde venous flow have been reported following adult and adolescent varicocelectomy but the significance remains unclear. We sought to determine the incidence and natural history of persistent flow and whether it had any effect on postoperative testicular catch-up growth. Materials and Methods: We retrospectively analyzed pre-varicocelectomy and post-varicocelectomy Doppler duplex ultrasound findings. Peak retrograde venous flow, maximum vein diameter, flow quality and varicocele grade were recorded at each visit. Catch-up growth was defined as less than 15% testicular asymmetry at final visit. Results: Of 330 patients (median age 15.4 years) undergoing varicocelectomy (laparoscopic in 247, open in 83) 145 had residual retrograde venous flow after Valsalva maneuver with a mean peak of 13.3 cm per second. Of 290 patients with repeat Doppler duplex ultrasound (median followup 2.6 years) 124 had initial peak retrograde venous flow less than 20 cm per second (43%) and only 17 (6%) had flow 20 cm per second or greater. Incidence of post-varicocelectomy retrograde venous flow at last visit (48%) was similar to that at initial postoperative visit (49%). Of 330 boys 20 had recurrence of palpable varicocele (grade 2 or 3), of whom 18 (90%) had initial retrograde venous flow. Catch-up growth was more likely in patients with no retrograde venous flow, and rates of catch-up growth decreased as peak retrograde venous flow increased. All 5 patients with initial testicular asymmetry and persistent retrograde venous flow at levels greater than 30 cm per second had continued testicular asymmetry (ie none had catch-up growth). Conclusions: Retrograde venous flow is frequently present after varicocelectomy and is almost always associated with peak retrograde venous flow rates significantly lower than those seen in patients who are recommended for initial varicocelectomy. Retrograde venous flow tends to persist during followup at stable peak retrograde venous flow rates. Palpable recurrence and persistent testicular asymmetry are most often associated with postoperative peak retrograde venous flow rates 20 cm per second or greater. References 1 : Assessment of adolescent varicocele. Pediatr Surg Int1997; 12: 410. Google Scholar 2 : The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. BJU Int2000; 86: 490. 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Link, Google Scholar Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byNiederberger C (2018) Re: Youth Varicocele and Varicocele Treatment: A Meta-Analysis of Semen OutcomesJournal of Urology, VOL. 193, NO. 4, (1331-1331), Online publication date: 1-Apr-2015.Ritchey M (2018) This Month in Pediatric UrologyJournal of Urology, VOL. 190, NO. 2, (375-376), Online publication date: 1-Aug-2013. Volume 190Issue 2August 2013Page: 689-695 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsurologic surgical procedures, maleultrasonography, Doppler, duplexvaricocelepediatricsMetricsAuthor Information Jason P. Van Batavia More articles by this author Angela M. Fast More articles by this author Shannon N. Nees More articles by this author Miguel A. Mercado Current address: Department of Urology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030. More articles by this author Anthony Gaselberti More articles by this author Kenneth I. Glassberg More articles by this author Expand All Advertisement PDF downloadLoading ...
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