Assessment of adolescent varicocele

Varicocele is the most important male factor responsible for decreased fertility potential in married couples. From March through June 1994, 2,470 school boys aged 10–20 years were examined to establish the incidence of consecutive grades of varicocele and to develop a protocol for diagnosis and treatment of adolescents with varicocele. Grade 1 varicocele was found in 18%, grade 2 in 12%, and grade 3 in 5% of the population examined. An original protocol of ultrasonographic (US) examination (previously verified by angioscintigraphy) was introduced to assess boys with clinically diagnosed varicocele. The volume of each testis, testicular volume decrease (TVD), pampiniform vein diameter (PVD), and basal (BBF) and maximum blood flow (MBF) velocities were measured in 625 boys. In 74 cases a semen analysis was performed. The statistical analysis revealed that the presence of venous reflux and PVD correlated with the grade of varicocele. Decreases in testicular volume were highly dependent on the grade of varicocele, PVD, and BBF and MBF velocities. Analysis of the relationship between spermatic (boys over 17 years) and US findings revealed that the quality of spermatogenesis can be predicted by US examination in adolescents with varicocele. The authors recommend multiparametric US examination as a reliable, objective, and repeatable technique for establishing criteria for operative treatment in boys under 18 years of age with varicocele as well as for postoperative evaluation.     

Management of adolescent varicocele

Varicocele is defined as an abnormal dilation and tortuosity of the internal spermatic veins found within the pampiniform plexus. It is a common finding in adolescents and adult men alike, however its diagnosis in the adolescent population poses different dilemmas in regard to indications for treatment than in adults. Failed Paternity is a clear-cut indication for repair in adult men attempting to father children. In adolescents, the physicians, family and patients must consider potential for future fertility problems which may or may not actually become of concern. Assessing the degree of negative effect of the varicocele on an adolescent's testicular health can also be difficult as teenagers typically are not asked to provide semen for analysis and thus surrogate markers for testicular health such as testicular size differentials must be used. Treatment options for the adolescent varicocele are similar to options in adult populations. While risks and benefits of various techniques can be considered, the gold standard for varicocele repair in adolescents has not been clearly defined.We aim to discuss diagnosis of varicocele, considerations for initiating treatment of varicocele in the adolescent, and techniques for management.     

Evolving management of adolescent varicocele

ObjectiveTo review the evolution in indications for treatment and treatment modalities for adolescent varicocele at our centre, and evaluate the impact of varicocelectomy on final outcome.Patients and methodsBetween 1995 and 2006, we treated 242 left varicoceles. Preoperative assessment included clinical evaluation, measurement of testicular volumes, and colour-Doppler ultrasound (CDUS). A subinguinal varicocelectomy was performed in 124 patients (group A), and a laparoscopic non-artery-sparing Palomo procedure in the remaining 118 (group B). In group B patients, CDUS was also used to investigate the functional anatomy of varicocele, and all the veins found to be refluxing were divided during surgery. The two groups were compared with regard to indications for surgery and outcome.ResultsOver time the proportion of patients operated on because of testicular growth retardation increased. Persistence/recurrence rate was comparable between the two groups. In 13% of group B patients, the deferential vein was found to be refluxing on preoperative CDUS and was divided at surgery. Hydrocele rate was higher in group A, unless the vaginalis was excised and everted during varicocelectomy. About 75% of patients with preoperative left testicular growth failure experienced postoperative catch-up growth, irrespective of treatment.ConclusionIndications for treatment are still evolving. Varicocele can successfully be treated in the majority of cases by either a laparoscopic or subinguinal approach. Both techniques require care, and CDUS can aid in the decision making. Most patients with preoperative testicular growth failure experience postoperative catch-up growth.     

Testicular histology in the adolescent with a varicocele

A varicocele is a common cause of adult male infertility, and surgical ligation is a generally accepted mode of therapy. However, the guidelines for management of the adolescent with a varicocele are not clearly defined. Herein, we describe histologic abnormalities noted on testis biopsy in nine of 24 boys with moderate to large varicoceles. Surgical ligation of the varicocele is recommended when there is volume loss of the testis ipsilateral to the varicocele. All others should be reexamined periodically, and an attempt should be made to obtain a baseline semen analysis.     

青少年精索静脉曲张诊断评估与治疗干预新进展

青少年精索静脉曲张(varicocele,VC)发病率不断增高,对患儿身体发育和生殖健康带来显著影响,已引起医学界广泛关注。VC的发病原因除了已知的解剖因素外,还包括胡桃夹现象(nutcracker phenomenon,NCP)、遗传因素等,对青少年VC的临床诊断和评估至关重要。精液检查虽然是对VC疾病最准确的评估措施,但在青少年患儿中往往无法获取精液样本,除此之外,监测双侧睾丸体积发育差异、彩色多普勒血流成像、内分泌检查等方法也是很有意义的评估依据和随访措施。青少年VC的治疗方案主要包括观察随访和外科干预,争论的焦点集中在手术指征及对手术方案的选择上。虽然目前仍无充足证据证明在传统开放手术、腹腔镜手术和显微镜精索静脉结扎术中哪种是最佳的手术方式,但是术中保留淋巴管可以显著减少手术并发症,特别是显微外科技术可以清晰显示精索内动脉、静脉及淋巴管等结构,在青少年VC手术治疗方面有良好的应用前景,但其技术优势仍需更多的循证医学证据。     

青少年精索静脉曲张诊断评估与治疗干预新进展

青少年精索静脉曲张(varicocele,VC)发病率不断增高,对患儿身体发育和生殖健康带来显著影响,已引起医学界广泛关注。VC的发病原因除了已知的解剖因素外,还包括胡桃夹现象(nutcracker phenomenon,NCP)、遗传因素等,对青少年VC的临床诊断和评估至关重要。精液检查虽然是对VC疾病最准确的评估措施,但在青少年患儿中往往无法获取精液样本,除此之外,监测双侧睾丸体积发育差异、彩色多普勒血流成像、内分泌检查等方法也是很有意义的评估依据和随访措施。青少年VC的治疗方案主要包括观察随访和外科干预,争论的焦点集中在手术指征及对手术方案的选择上。虽然目前仍无充足证据证明在传统开放手术、腹腔镜手术和显微镜精索静脉结扎术中哪种是最佳的手术方式,但是术中保留淋巴管可以显著减少手术并发症,特别是显微外科技术可以清晰显示精索内动脉、静脉及淋巴管等结构,在青少年VC手术治疗方面有良好的应用前景,但其技术优势仍需更多的循证医学证据。     

三种手术方式治疗青少年精索静脉曲张242例

目的探讨青少年精索静脉曲张(varicocele,VC)的手术方式及疗效。方法 2011年6月至2014年12月在本院泌尿外科进行手术治疗的青少年VC患者242例,根据手术方式分为三组:腹腔镜手术组52例,腹膜后手术组127例,显微镜手术组63例。比较三组手术时间、术后住院时间、并发症、复发以及术后症状改善情况。结果三组均顺利完成手术,并获随访9个月。三组手术时间比较,差异有统计学意义(P<0.05)。显微镜手术组手术时间明显长于另外两组,腹腔镜手术组和腹膜后手术组无差异(P>0.05);三组术后住院时间比较,差异无统计学意义(P>0.05);腹腔镜手术组术后发生3例尿潴留,2例阴囊积液,术后并发症的发生率9.62%;腹膜后手术组术后发生7例尿潴留,4例阴囊积液,术后并发症的发生率8.66%;显微镜手术组无术后并发症,三组差异有统计学意义(x^2=6.084,P=0.048<0.05),显微镜手术组并发症的发生率低于另外两组,另外两组比较无明显差异。比较术后症状(睾丸疼痛、阴囊坠涨、阴囊表面异常团块)改善情况,腹膜后组症状改善120例,腹腔镜组症状改善50例,显微镜组症状改善60例,三组症状改善元明显统计学差异(x^-=0.224,P=0.894>0.05)。显微镜手术组术后未见复发,腹腔镜手术组术后复发5例,复发率9.62%;腹膜后手术组术后复发12例,复发率9.45%·,三组比较差异有统计学意义(x^2=6.437,P=0.040<0.05),显微镜手术组并发症的发生率低于另外两组,另外两组比较无明显差异。结论从目前随访结果来看,显微镜手术组手术效果优于另外两组。腹腔镜手术组更适合于双侧VC患者,腹膜后手术组简单易行,且花费较低。三种术式手术效果尚需进一步随访。     

Controversies in male adolescent health: varicocele, circumcision, and testicular self-examination

PURPOSE OF REVIEW: The authors review three common clinical controversies encountered by primary care providers of adolescent males: management of varicoceles, the role of circumcision in the acquisition and transmission of sexually transmitted infections, and the value of teaching testicular self-examination. RECENT FINDINGS: Recent findings in adolescent varicoceles have advanced knowledge regarding the cause of varicoceles, the mechanism by which they may lead to infertility, new screening methods, and optimal surgical management. Accumulating evidence shows circumcision to be protective against acquisition and transmission of sexually transmitted infections, and preliminary work also indicates the potential for protection against the spread of AIDS in Africa. Testicular self-examination remains an unproven screening modality that is suboptimally performed by at-risk patients. SUMMARY: This review updates the provider on these topics and clarifies issues involved in these controversies     

Adolescent varicocele.

The evaluation and management of adolescents with varicoceles continue to evolve. Current recommendations for repair are based on the findings of impaired testicular growth or spermatogenesis; however, with early evaluation and selective treatment, clinicians should be able to reduce the potential for future fertility problems significantly in adolescents with varicoceles.     

The hypertensive adolescent

The hypertensive adolescent requires a careful blood pressure evaluation. In most cases, extensive diagnostic studies will not be necessary, particularly if the patient exhibits characteristics of early essential hypertension. On the other hand, further evaluation should not be withheld in the absence of risk factors or the presence of significant hypertension. A management plan that includes patient education is appropriate for all adolescents with hypertension. In some, but not all, hypertensive adolescents, a limited course of medication may be beneficial.