Adolescent varicocele repair

Kumar, R.; Yadav, R.
January 2006
Indian Journal of Urology;Jan-Mar2006, Vol. 22 Issue 1, p84
Academic Journal
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.


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