Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns. Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. Effects of varicocelectomy on testis volume and semen parameters in adolescents: a randomized prospective study. Sperm chromatin condensation in infertile men with varicocele before and after surgical repair. [Transumbilical single-site single-port versus single-site double-port laparoscopic varicocelectomy for varicocele in adolescents]. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele. Expression of the HSPA2 gene in ejaculated spermatozoa from adolescents with and without varicocele. Diagnosis of Pediatric Varicoceles by Physical Examination and Ultrasonography and Measurement of the Testicular Volume
OBJECTIVE To investigate different varicocele hemodynamic patterns ( shunt type vs. stop type ) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy . DESIGN Prospect i ve clinical study . SETTING Department of pediatric urology , children 's hospital medical center . PATIENT(S ) Seventy-four children and adolescents with varicocele . INTERVENTION(S ) Based on ultrasound findings , patients were classified into shunt-type or stop-type varicocele groups . All patients with stop-type varicocele and testicular volume discrepancy of ≥20 % underwent retroperitoneal varicocelectomy and internal spermatic vein ligation .  Patients with shunt-type varicocele and ≥20 % testicular asymmetry were r and omly divided to undergo either retroperitoneal varicocelectomy ( ligation of internal spermatic vein ) or inguinal varicocelectomy with ligation of both internal and external spermatic veins . Patients with testicular volume discrepancy of < 20 % were put on conservative management . MAIN OUTCOME MEASURE(S ) Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients . RESULT ( S ) Patients with shunt-type varicocele who did not undergo surgery revealed a higher risk of developing asymmetry during follow-up ( odds ratio 10.5 ) . Ligation of both internal and external spermatic veins in shunt-type patients was associated with significantly decreased rate of recurrence ( 6.3 % ) compared with retroperitoneal approach ( 30.8 % ) . CONCLUSION ( S ) Shunt-type varicocele is associated with a higher risk of testicular hypotrophy among untreated patients . In addition , recurrence rate in shunt-type patients who underwent inguinal varicocelectomy was lower compared with retroperitoneal approach To evaluate , in a r and omized prospect i ve trial in children and adolescents , the feasibility of isosulphan blue‐based lymphatic vessel preservation during laparoscopic varicocelectomy  and its impact on the complication rate , as the operative management of varicoceles remains controversial PURPOSE We review the long-term results of varicocele repair , and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital . MATERIAL S AND METHODS We prospect ively studied 100 males 7 to 19 years old with clinical palpable varicocele . Of the patients 52 ( 52 % ) underwent left unilateral varicocelectomy  and 48 ( 48 % ) underwent bilateral varicocelectomy . Varicocelectomy 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 subinguinal or inguinal approach . Postoperative complications were compared in all patients based on technique . Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients . RESULTS Mean postoperative followup was 30.4 + /- 13.06 months ( 12 to 65 ) . Total motile sperm count increased from 22.6 million + /- 5.16 million to 64.53 million + /- 12.3 million postoperatively , which was statistically significant ( p = 0.002 ) . Postoperative recurrence rates were 0 % in cases managed by microsurgical varicocelectomy , 2.9 % in those where loupe magnification was used and 8.8 % in those where no magnification was used . Postoperative hydrocele rates in these cases were 0 % , 2.9 % and 5.9 % , respectively . The highest rates of recurrence and hydrocele were observed in cases where no magnification was used , compared to those managed by microsurgery ( p = 0.03 and p = 0.116 , respectively ) . CONCLUSIONS Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates . Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification , such as microscopy . Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles Because the treatment of a varicocele in adolescents remains controversial , we undertook a prospect i ve study in 51 male adolescents , aged 15 - 21 years , who were referred for a varicocele . Twenty-nine patients were treated with high retroperitoneal ligation of the left spermatic vein , and 22 were untreated . Eighteen healthy adolescent volunteers without a varicocele were also assessed .  Testicular volume was measured using an orchiometer , and semen analyses were carried out at referral and after 1 year of follow-up . In addition , serum luteinizing hormone ( LH ) , follicle-stimulating hormone ( FSH ) and testosterone levels were estimated by radioimmunoassay . Both patient groups had significantly smaller testis volumes than the controls at the outset . In the follow-up , the treated patients had testis volumes similar to those of the controls . Both testes increased significantly in volume after treatment . Although semen parameters were comparable in all groups initially , sperm concentration increased significantly after treatment of the varicocele . We concluded that varicocele treatment in adolescents leads to increased testis volume and a higher sperm concentration ; however , whether early treatment will improve testicular function remains to be eluci date OBJECTIVE To assess sperm chromatin integrity in infertile men with varicocele before and after surgical repair . DESIGN Prospect i ve . SETTING Academic setting . PATIENT(S ) Seventy-two infertile men with varicocele compared with 20 healthy fertile men . INTERVENTION(S ) History taking , genital examination , semen analysis , sperm chromatin condensation assessment by aniline blue stain before and 3 months after varicocelectomy . MAIN OUTCOME MEASURE(S ) Stained sperm heads ( abnormal chromatin condensation ) before and 3 months after varicocelectomy . RESULT ( S ) The mean percentage of aniline blue-stained sperm heads was significantly higher in infertile men with varicocele compared with fertile controls . The mean percentage of stained sperm heads was significantly decreased in infertile men with varicocele 3 months after surgery compared with the preoperative data . There was a significant negative correlation between percentage of stained sperm heads and normal morphology where nonsignificant correlation was elicited regarding sperm count and sperm motility . CONCLUSION ( S ) There is a significant increase of abnormal sperm chromatin condensation in infertile men with varicocele that is markedly improved after varicocelectomy OBJECTIVE To compare the effect of transumbilical single-site single-port with that of transumbilical single-site double-port laparoscopic varicocelectomy in the treatment of varicocele in adolescents . METHODS We r and omly assigned 80 varicocele patients aged 10 - 16 years to two groups of equal number to receive transumbilical single-site single-port and single-site double-port laparoscopic varicocelectomy , respectively . We compared the operation time , postoperative hospital stay , incisional pain , complications and satisfaction with the abdominal cosmetic outcomes between the two groups . RESULTS All the operations were successfully performed . The double-port group showed a significantly higher score on the Visual Analogue Scale than the single-port group ( 4.8 + /- 1.4 vs 3.6 + /- 1.1 , t = -4.986 , P < 0.01 ) , but there were no significant differences between the two groups in the operation time ( [ 29.8 + /- 4.2 ] vs [ 31.2 + /- 4.6 ] min , t = 1.383 , P = 0.171 ) , postoperative hospital stay ( [ 1.95 + /- 0.7 ] vs [ 1.82 + /- 0.8 ] d , t = -0.784 , P = 0.436 ) , complications ( 0 vs 0 ) and scores on the satisfaction with abdominal cosmetic outcomes ( 4.6 + /- 0.6 vs 4.8 + /- 0.5 , t = 1.253 , P = 0.214 ) . No recurrence , umbilical hernia , hydrocele and orchiatrophy were found in the two groups of patients at 6 months after operation , and no visible scar was observed on the abdominal surface . CONCLUSION With strict surgical indications , single-site single-port and single-site double-port laparoscopic varicocelectomies have similar clinical effects in the treatment of varicocele , which leave no scar on the abdominal surface . Single-site double-port laparoscopy needs no special instruments and therefore is worthier of wide clinical application The aim of this prospect i ve study was to assess long-term functional results ( spermiograms ) in subjects who underwent laparoscopic varicocelectomy via either of 2 procedures ( ligation or preservation of testicular artery ) . A total of 122 patients underwent laparoscopic varicocelectomy performed via either of the 2 different procedures : complete ligation of the spermatic vessels or preservation of the spermatic artery . After surgery when patients achieved 18 years , they were asked to undergo semen analysis . Spermiogram results were divided into 2 subgroups : " normal " and " abnormal . " We analyzed volume , sperm count per mL , percentage of motile spermatozoa , percentage of normal spermatozoa , and percentage of vitality for each group . Both groups showed the same results in terms of " normal " and " abnormal " spermiograms ( World Health Organization criteria ) , but analysis showed higher sperm concentration per mL , sperm motility , volume , vitality , and rate of morphologically normal sperm for the group with arteries preserved and " normal " spermiograms ( P < .01 ) . Analysis of data from the spermiograms showed that preservation of the testicular artery was the best possible option in terms of semen quality . Therefore , we believe that surgical treatment of varicocele should be carried out using procedures involving artery preservation OBJECTIVE To compare the surgical outcomes of subinguinal and high inguinal approaches for microsurgical varicocelectomy . METHODS A total of 81 patients with left varicocele were r and omly assigned to undergo  microsurgical left varicocelectomy by the subinguinal ( n = 41 ) or high inguinal ( n = 40 ) approach . These two techniques were compared with regard to the operative parameters , complications and testicular growth . Anatomical parameters , including the numbers and diameters of internal spermatic arteries , veins and lymphatic vessels , were recorded . RESULTS The microsurgical step was significantly shorter for the high inguinal approach compared with the subinguinal approach ( 25.5 vs 33.3 min , respectively , P < 0.01 ) . The numbers of preserved arteries and ligated veins were significantly greater and the artery size was significantly smaller for the subinguinal ( 1.6 arteries , 11.5 veins and 1.1 mm , respectively ) compared with the high inguinal approach ( 1.2 arteries , 7.3 veins and 1.3 mm ; P < 0.001 , < 0.0001 and < 0.01 , respectively ) . There was one patient with postoperative hydrocele , and three with persistent scrotal pain after treatment with the subinguinal approach . The postoperative catch-up growth rates at 24 months were 70 % and 78 % for the subinguinal and high inguinal approaches , respectively . CONCLUSIONS The microsurgical subinguinal and high inguinal approaches seem to yield similar success rates in terms of testicular growth . However , the high inguinal approach is easier to carry out , as it requires fewer divisions of veins and is associated with a larger diameter of the spermatic artery OBJECTIVE To evaluate mRNA expression of the HSPA2 gene in ejaculated spermatozoa in adolescents with and without varicocele . DESIGN Controlled prospect i ve study . SETTING Patients in an academic research environment . PATIENTS Adolescent patients with clinical diagnosed bilateral varicocele grade s II and III , and adolescent patients without varicocele . INTERVENTION Reverse-transcription-polymerase chain reaction ( RT-PCR ) analysis of HSPA2 gene expression in adolescents with and without varicocele . MAIN OUTCOME MEASURE Comparative RT-PCR expression analysis of HSPA2 gene mRNA , compared to the housekeeping beta-actin gene . RESULTS Sperm from adolescents with varicocele and oligozoospermia had significantly lower levels of HSPA2 gene expression than both adolescents without varicocele ( controls ) and adolescents with varicocele and normal sperm concentration ( P<.05 ) . The latter group had a nonsignificant increase in gene expression compared to the control group . CONCLUSIONS This is the first report on HSPA2 gene expression in ejaculated spermatozoa from adolescents and its relationship with varicocele pathology . Results demonstrated that HSPA2 expression was down-regulated in adolescents with varicocele and oligozoospermia compared to controls . There was a higher , albeit nonsignificant , gene expression in adolescents with varicocele and normal sperm concentration than in controls . We speculate that expression levels of this gene might be used as a molecular marker for the acquisition of thermal tolerance in ejaculated spermatozoa Introduction : The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy . The aim of this study was to prospect ively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes . Patients and Methods : This study included 68 boys with varicoceles , ranging in age from 8 to 19 years . Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography . The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography . A difference of more than 10 % or 2 ml in each testicular volume was considered significant . Results : The mean age of the boys was 13.5 ± 2.3 years . On physical examination , a left unilateral varicocele was diagnosed in 46 boys ( 67.6 % ) . The other 22 boys ( 32.4 % ) had bilateral varicoceles . Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys ( 8.7 % ) who were diagnosed by physical examination as having only left unilateral varicoceles ( grade 3 in 3 patients and grade 2 in 1 patient ) . A different of more than 10 % or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles ( 2.2 % ) . The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test ( r = 0.997 and p < 0.001 for the left testis ; r = 0.998 and p < 0.001 for the right testis ) . Conclusions : Although the management of sub clinical varicoceles remains controversial , these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles , especially in boys with high- grade left varicoceles . In contrast , scrotal ultrasonography , if considered the gold st and ard , did not show superiority over the Prader orchidometer in measuring testicular volumes
Based on current available r and omized controlled trials , there is low to moderate level of evidence that radiological or surgical treatment of adolescent varicocele is associated with improved testicular size/growth and sperm concentration .
BACKGROUND The prevalence of varicoceles is as high as 15 % in children and adolescents .
Optimal management of varicoceles has not been consoli date d. Options include observation , radiological intervention , or surgical varicocelectomy .
OBJECTIVE Herein , we aim to assess the outcomes of radiological and surgical interventions for varicocele in children and adolescents evaluated by RCTs .