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UROSCAN
Year : 2006  |  Volume : 22  |  Issue : 1  |  Page : 84
 

Adolescent varicocele repair


Department of Urology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
R Kumar
Department of Urology, All India Institute of Medical Sciences, New Delhi
India
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How to cite this article:
Kumar R, Yadav R. Adolescent varicocele repair. Indian J Urol 2006;22:84

How to cite this URL:
Kumar R, Yadav R. Adolescent varicocele repair. Indian J Urol [serial online] 2006 [cited 2019 Jul 18];22:84. Available from: http://www.indianjurol.com/text.asp?2006/22/1/84/24673



   Summary Top


Prevalence of varicocele among adolescents is 7.8% in 11 to 14 year-olds and 14.1% in 15 to 19 year-olds. The author's previous study demonstrated that 7.3% of 11 to 14 year-old children and 9.3% of 15 to 19 year-olds were affected by varicocele-related testicular atrophy, while children younger than 11 years old were not affected. These findings support the theory that the incidence of varicocele and related testicular atrophy increase with puberty. Therefore many investigators have recommended early treatment when the testis is still developing, in order to preserve fertility. Recurrence following varicocelectomy range from 0% to 16.6%, based on the surgical technique used. In this study, the authors have reviewed the long-term results of varicocele repair and compared the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele. 100 males aged 7 to 19 years with clinical palpable varicocele were prospectively treated and followed up for at least 1 year after surgery. Of the patients 52 (52%) underwent left unilateral and 48 (48%) underwent bilateral varicocelectomy. Indication for varicocele repair were testicular hypotrophy or soft testis in 72 patients (72%), pain in 8 (8%) and a large varicocele without symptoms in 20 (20%). Surgery was performed using a microscope in 49 patients (79 sites), loupe magnification in 25 (35 sites) and no magnification in 26 (34 sites), using either a sub inguinal or inguinal approach. In all patients, postoperative complications including recurrence, hydrocele and testicular atrophy, were compared according to surgical techniques. Significant improvement in sperm counts was observed postoperatively. Recurrence rates were 0% in cases managed by microsurgical varicocelectomy, 2.9% with loupe magnification and 8.8%, where no magnification was used. Postoperative hydrocele rates were 0%, 2.9% and 5.9%, respectively. This study and previous studies have revealed that loupe magnification or no magnification is inadequate for meticulous dissection.


   Comments Top


This prospective study of a 100 patients, deals with two important issues in the management of varicoceles. This first is the direct comparison of three techniques of surgery i.e. with no magnification, with loupes and with a microscope. The second deals with the results of varicocelectomy for adolescents.

Adolescent varicocele continues to be a clinical enigma due to the lack of a standardized evaluation and treatment protocol. Urologists often find themselves at a loss, trying to advise correct treatment for adolescents who are brought to them for treatment of a symptomatic or asymptomatic varicocele. This article provides useful information in trying to identify patients who should be operated upon and also discusses the relative merits of each type of surgery. The authors defined testicular hypotrophy through a testicular size discrepancy of 2 ml or 10% or more between two testes, based on a Prader orchidometer. This formed the principal indication for surgery. Preoperative semen analysis, though performed in a third of the patients, was not used a criterion for operation. In the 33 adolescents who could provide a semen sample, they noted a significant improvement in total sperm counts and motile sperm counts, suggesting the need for surgery in these patients.

All surgeries were performed by one surgeon and though non-randomized, three different techniques of operation i.e. no magnification, loupes and microsurgery were used. The authors fail to define the criteria for choosing each option. However, they note that between the three groups, microsurgery has the lowest complication and recurrence rate. This corroborates the findings in adults where microsurgery has been found to be the best modality for operating varicoceles.[1],[2]

 
   References Top

1.Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol 1992;148:1808.  Back to cited text no. 1  [PUBMED]  
2.Cayan S, Kadioglu TC, Tafekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 2000;55:750.  Back to cited text no. 2    




 

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