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Optimizing the Operative Treatment of Boys with Varicocele: Sequential Comparison of 4 Techniques

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(05)63988-2

1527-3792

Marcus Riccabona, Josef Oswald, Mark Koen, Lukas Lusuardi, Christian Radmayr, Georg Bartsch,

Male Reproductive Health Studies

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Feb 2003Optimizing the Operative Treatment of Boys with Varicocele: Sequential Comparison of 4 Techniques MARCUS RICCABONA, JOSEF OSWALD, MARK KOEN, LUKAS LUSUARDI, CHRISTIAN RADMAYR, and GEORG BARTSCH MARCUS RICCABONAMARCUS RICCABONA , JOSEF OSWALDJOSEF OSWALD , MARK KOENMARK KOEN , LUKAS LUSUARDILUKAS LUSUARDI , CHRISTIAN RADMAYRCHRISTIAN RADMAYR , and GEORG BARTSCHGEORG BARTSCH View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63988-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared 4 techniques of varicocele ligation in boys and young adolescents to determine the optimal operative treatment that avoids varicocele recurrence and postoperative hydrocele formation. Materials and Methods: In 10 years a total of 128 varicocelectomies were performed sequentially in 121 boys and young adolescents with a mean age of 12 years using the laparoscopic, inguinal testicular artery sparing, standard Palomo (high mass retroperitoneal ligation) and modified Palomo approaches. The modified Palomo approach involved suprainguinal and retroperitoneal ligation of the veins and artery, and microsurgical sparing of the blue stained lymphatic pathway of the testis. Patients were followed a mean of 52 months. Results: In the 19 boys in the laparoscopy group varicocele persisted in 10% and hydrocele developed in 5%. In the 21 patients who underwent inguinal surgery with artery preservation recurrent varicoceles were identified in 14% and no hydroceles were observed. In the 32 patients who underwent the standard Palomo procedure there was no palpable varicocele persistence or recurrence, while hydroceles developed in 12%. Of the 56 patients in the modified Palomo group varicocele recurred in 1 (2%) and there were no hydroceles. No testicular atrophy developed in any patient. Conclusions: Comparison of all 4 groups revealed significant differences in varicocele recurrence (p = 0.038) and hydrocele formation (p = 0.023). Pairwise group comparison showed that the modified Palomo technique resulted in a significant decrease in the incidence of postoperative hydrocele formation compared with the standard Palomo method (p = 0.015). This procedure can be recommended as the optimal surgical technique for varicocele treatment in males of this young age. References 1 : Adolescent varicocele: objective indications for treatment. J Urol1989; 142: 579. Link, Google Scholar 2 : Reversal of testicular growth failure by varicocele ligation. J Urol1987; 137: 475. Link, Google Scholar 3 : Comparison among different methods for the diagnosis of varicocele. Fertil Steril1985; 43: 575. 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Google Scholar From the Department of Pediatric Urology, Krankenhaus Barmherzige Schwestern, Linz and Department of Urology, University of Innsbruck, Innsbruck, Austria© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byNees S and Glassberg K (2018) Observations on Hydroceles Following Adolescent VaricocelectomyJournal of Urology, VOL. 186, NO. 6, (2402-2407), Online publication date: 1-Dec-2011.Woldu S, Van Batavia J, Poon S, Raimondi P and Glassberg K (2010) Is Adolescent Varicocelectomy Safe After Previous Inguinal Surgery?Journal of Urology, VOL. 184, NO. 4S, (1716-1721), Online publication date: 1-Oct-2010.Barroso U, Andrade D, Novaes H, Netto J and Andrade J (2018) Surgical Treatment of Varicocele in Children With Open and Laparoscopic Palomo Technique: A Systematic Review of the LiteratureJournal of Urology, VOL. 181, NO. 6, (2724-2728), Online publication date: 1-Jun-2009.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.Feber K and Kass E (2008) Varicocelectomy in Adolescent Boys: Long-Term Experience With the Palomo ProcedureJournal of Urology, VOL. 180, NO. 4S, (1657-1660), Online publication date: 1-Oct-2008.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.Makari J, Atalla M, Belman A, Rushton H, Kumar S and Pohl H (2018) Safety and Efficacy of Intratesticular Injection of Vital Dyes for Lymphatic Preservation During VaricocelectomyJournal of Urology, VOL. 178, NO. 3, (1026-1030), Online publication date: 1-Sep-2007.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.KOČVARA R, DVOŘÁČEK J, SEDLÁČEK J, DÍT˘E Z and NOVÁK K (2018) LYMPHATIC SPARING LAPAROSCOPIC VARICOCELECTOMY: A MICROSURGICAL REPAIRJournal of Urology, VOL. 173, NO. 5, (1751-1754), Online publication date: 1-May-2005.ESPOSITO C, VALLA J, NAJMALDIN A, SHIER F, MATTIOLI G, SAVANELLI A, CASTAGNETTI M, McKINLEY G, STAYAERT H, SETTIMI A, JASONNI V and GUYS J (2018) Incidence and Management of Hydrocele Following Varicocele Surgery in ChildrenJournal of Urology, VOL. 171, NO. 3, (1271-1273), Online publication date: 1-Mar-2004. Volume 169Issue 2February 2003Page: 666-668 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordslymphatic systemvaricoceletestishydroceleMetricsAuthor Information MARCUS RICCABONA Requests for reprints: Department of Paediatric Urology, Krankenhaus Barmherzige Schwestern, Seilerstätte 4, A-4010 Linz, Austria. More articles by this author JOSEF OSWALD More articles by this author MARK KOEN More articles by this author LUKAS LUSUARDI More articles by this author CHRISTIAN RADMAYR More articles by this author GEORG BARTSCH More articles by this author Expand All Advertisement PDF downloadLoading ...