Adolescent Varicocelectomy: Success at What Cost? Clinical Outcome and Cost Comparison of Surgical Ligation and Percutaneous Embolization
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Objectives: Evaluate clinical outcome, recurrence, morbidity, and cost associated with laparoscopic surgical ligation versus percutaneous embolization of adolescent varicocele. We hypothesize that both approaches are similar in outcomes, complications, and cost. Materials and Methods: A retrospective review of 56 consecutive adolescent males, ≤18 years from 2006 to 2016 with clinical varicocele who underwent laparoscopic surgical ligation or percutaneous embolization. Patient demographics, operative time, postoperative complications, success, varicocele grade, recurrence, and hospital charges were abstracted. Results: Mean age was 14.2 ± 2.1 years; 48 (86%) patients having undergone laparoscopic surgical ligation and 8 (14%) percutaneous embolization. Intervention in 45 (80%) patients was for testicular hypotrophy (mean 27.4% ± 15.6%) and 11 (20%) for pain symptomology. Median follow-up was 17.5 months (range 1–65 months). After ligation, 2 (4%) patients developed hydroceles (1 with subsequent hydrocelectomy) and 6 (12%) varicocele recurrence. There were no cases of hydrocele or varicocele recurrence after percutaneous embolization. Twenty ligation patients had postoperative scrotal ultrasound demonstrating an increase in testicular volume by a reduction in difference in testicular volume from 27.3% ± 14.7% preoperatively to 11.2% ± 13.6% postoperatively (P < .001). There was significant difference in mean operative time between the groups (surgical ligation 41.3 minutes versus percutaneous embolization 117.9 minutes, P < .001) and hospital charges for the procedure (surgical ligation $3983 versus percutaneous embolization $18.165, P < .001). Conclusions: Contrary to our hypothesis, percutaneous embolization has seemingly lower rates of postoperative hydrocele and varicocele recurrence in comparison to surgical ligation but with three times the exposure to general anesthesia and at four times the price.Keywords:
Hydrocele
Testicular pain
Five patients were treated for varicocele by embolization with the use of ethanol, which has not been used before. The ethanol was injected into the spermatic vein involved in the varicocele by the technique of spermatic venography. Embolization was successful in all five patients. During the follow-up period, the varicocele became smaller or disappeared in four of the five patients. In one patient, catheterization was difficult, and the effect of ethanol was unsatisfactory because of the location of its release. The varicocele appeared again 13 months after embolization. Serious side effects were not found in all patients. Embolization therapy with ethanol is easily performed and is considered to be a safe and effective method.
Venography
Spermatic Vein
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To evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation.In all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3-12) months.The mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%.Microscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the 'gold standard' for varicocelectomy.
Hydrocele
Spermatic cord
Spermatic Vein
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Abstract Background Lymphatic sparing laparoscopic Palomo varicocelectomy is a safe and reliable technique for varicocele treatment in adolescents and children. The purpose of this study was to compare the outcomes of lymphatic sparing laparoscopic varicocelectomy with and without testicular artery preservation. The prospective random allocation of selected patients was done at Al-Azhar University Hospital, Pediatric Surgery Department from February 2010 till January 2015. All patients underwent lymphatic sparing laparoscopic varicocelectomy and they were divided into two equal groups, group A underwent laparoscopic Palomo without testicular artery sparing and group B underwent the procedure with testicular artery sparing. The main outcome included operative time, postoperative hydrocele, and persistence of varicocele, together with catch-up testicular growth or testicular atrophy. Results One hundred and sixty male patients presented with left-sided primary varicocele that was diagnosed clinically and affirmed by color Doppler ultrasonography. The mean age was 14.25 ± 1.6 years (ranged 13-16 years). There was one case of persistent varicocele in group A, compared to 8 cases in group B with a statistically significant difference ( p = 0.016). A significant difference had been found in the operative time ( p = 0.001) between both groups. No hydrocele or testicular atrophy had been detected in both groups. No significant inter-group differences were seen in aspects of age, varicocele grade, and catch-up testicular growth. The mean follow-up period was 42 months (24-60 months). Conclusion Lymphatic sparing laparoscopic Palomo varicocelectomy was superior to that with testicular artery preservation as regard varicocele persistence and operative time and hence is preferable for the management of primary pediatric varicocele.
Hydrocele
Testicular atrophy
Testicular artery
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Background: Varicocele is the abnormal dilatation of pampiniform venous plexus and internal spermatic vein. It is the commonest surgically correctable cause of male infertility. We reviewed pattern of presentation and management of varicocele in our hospital.Methodology: This is a retrospective review of 100 patients managed for varicocele in our hospital from January 2011 to August, 2020. Data was collected via a proforma and was analyzed using SPSS version 25.0. The results were reported in percentages, mean ± standard deviation.Results: The mean age of the patients was 35.2 ± 8.4 years with a range of 17 to 58 years. The varicocele was asymptomatic in 86 patients (86%), it was during evaluation for infertility. There were symptoms in 16 single young patients. The symptoms include scrotal pain and discomfort in 14 patients (14%) each and scrotal swelling in 7 patients (7%). There were co-morbidities in 7 patients (7%). There were abnormal seminal fluid parameters in 75 patients (75%), low testosterone in 23 patients (23%), testicular atrophy and or primary testicular failure in 51 patients (51%). Open sub-inguinal varicocelectomy was done in 67 patients (67%), 60% as day cases. The overall rate of improvement in seminal fluid parameters and pregnancy rates were 68.6 % and 11.9% respectively. There was resolution of symptoms in all the 16 symptomatic cases. Conclusion: Varicocele is a common cause of infertility in our environment and most patients are discovered during evaluation for infertility. Patients present late with testicular dysfunction with or without primary testicular failure. Varicocelectomy was associated with good symptomatic response, improvement in seminal fluid parameters but low pregnancy rate due to testicular atrophy.
Testicular atrophy
Testicular pain
Presentation (obstetrics)
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Varicocele is the main cause of infertility in male and the most correctable cause of it too. In this study, we present our experience on 34 patients affected by bilateral varicocele and other scrotal comorbidities treated underwent surgery with a scrotal access.34 patients were enrolled with clinical palpable and infraclinical (ultrasonic doppler scanning) bilateral varicocele and other comorbidities like right hydrocele, left hydrocele, bilateral hydrocele, and epididymal cyst. They all underwent scrotal bilateral varicocelectomy under local anesthesia.At 6 months, no other complications were reported. No case of testicular atrophy was observed. None had recurrence of varicocele. All scrotal comorbidities were treated as well.Scrotal access with local anesthesia is a safe and useful technique to treat patients with bilateral varicocele and other scrotal comorbidities.
Hydrocele
Testicular atrophy
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Varicocele is the most common correctable cause of male infertility. It is found in 35 and 80% of patients with primary and secondary infertility respectively. The most effective treatment for varicocele is surgery. Varicocelectomy is associated with a lot of complications, hydrocele is the most common of which, and it affects about 20% of patients. Many techniques have been done to reduce the incidence of postvaricocelectomy hydrocele which is difficult to be done here nowadays. In this study we decided to do Jaboulay's operation (the operation for hydrocele) at the same time of varicocelecto my .We applied this maneuver for 76 patients and of course and we got no postoperative hydrocele. So we recommend combining Jaboulay's operation with varicocelectomy for all patients with varicocele to avoid the occurrence of hydrocele and the need for a second surgery. ﺔﻴﻠﻤﻋ ﺞﻤﺩ ﻲﻟﻭﺒﺎﺠ ﺍ ﻲﻟﺍﻭﺩ لﺎﺼﺌﺴﺍ ﺔﻴﻠﻤﻋ ﻊﻤ ﺔﻴﺌﺎﻤﻟﺍ ﺔﻠﻴﻘﻠﻟ ﺔﻴﺼﺨﻟ
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Concomitant
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Hydrocele
Testicular pain
Scrotal Pain
Triage
Primary care physician
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This was a prospective study to evaluate the experience of varicocele management during ipsilateral herniorrhaphy in an inpatient urology setting.A total of 65 patients with varicocele and inguinal hernia scheduled for herniorrhaphy were included for evaluation. They were categorized into 3 groups. Group 1 (n = 20) had painful varicocele and underwent simultaneous herniorrhaphy and varicocelectomy; group 2 (n = 20) had asymptomatic varicocele and received simultaneous herniorrhaphy and varicocelectomy; and group 3 (n = 25) had asymptomatic varicocele and underwent herniorrhaphy only. We used the Bassini method for herniorrhaphy and inguinal microsurgical varicocelectomy for varicocele. Varicocele was diagnosed by physical examination and further confirmed by Doppler ultrasonography.The mean follow-up was 30.2 months (range, 6-56 months). Of the 20 subjects in group 1, complete resolution of scrotal pain was noticed in 14 (70%), and 2 (10%) had hydrocele after varicocelectomy. Of the 20 patients in group 2, 1 (5%) had hydrocele after surgery, and no hydrocele was noticed in group 3 after surgery. Mean operation time was significantly longer in group 1 (70.5 + or - 15.2 minutes) and group 2 (69.8 + or - 14.5 minutes) than in group 3 (38.2 + or - 17.2 minutes). One case in group 1 had recurrent varicocele 6 months after surgery. Of the 25 subjects in group 3, 2 (8%) developed painful varicocele during the follow-up period, and both of them had indirect inguinal hernia and lower body mass index.Simultaneous herniorrhaphy and varicocelectomy are suggested for patients who have inguinal hernia and ipsilateral varicocele, but the average operation time is significantly longer and there is a higher rate of hydrocele than with herniorrhaphy only.
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We investigated the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain. We retrospectively reviewed the records of patients who underwent varicocelectomy. The age, body mass index, grade, laterality of varicocele, testicular volume difference, time to hospital visit, serum testosterone level and semen parameters were evaluated. A total of 954 patients were included. The painful group had lower mean age, lower BMI, higher grade of varicocele, smaller testicular volume difference and shorter time to hospital visit than the painless group. In addition, the median serum total testosterone level and total sperm count, concentration and motility were higher in the painful group than in the painless group. In multivariate analysis, there were significant differences between the two groups in age, grade of varicocele, testis volume difference, time to hospital visit, total sperm count and concentration. Patients with painful varicocele visited hospital earlier because of the pain and tended to start treatment sooner. They were also younger, had smaller testis atrophy and had higher sperm concentration, even though they had a higher grade of varicocele than patients without pain. Although scrotal pain in varicocele patients is difficult to treat, it leads to early diagnosis and treatment.
Testicular atrophy
Scrotal Pain
Testicular pain
Semen Analysis
Testicular volume
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