1
|
Esposito C, Borgogni R, Chiodi A, Cerulo M, Autorino G, Esposito G, Coppola V, Del Conte F, Di Mento C, Escolino M. Indocyanine green (ICG)-GUIDED lymphatic sparing laparoscopic varicocelectomy in children and adolescents. Is intratesticular injection of the dye safe? A mid-term follow-up study. J Pediatr Urol 2024; 20:282.e1-282.e6. [PMID: 38061982 DOI: 10.1016/j.jpurol.2023.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/11/2023] [Accepted: 11/18/2023] [Indexed: 04/22/2024]
Abstract
BACKGROUND Laparoscopic Palomo varicocelectomy using indocyanine green (ICG) fluorescent lymphography (FL) is standardized technique to perform lymphatic sparing and avoid post-operative hydrocele. No data regarding the safety of intratesticular injection of ICG are currently available. OBJECTIVE The study aimed to assess the safety and efficacy of this procedure at mid-term follow-up. STUDY DESIGN Seventy-two patients (median age 14.5 years) undergoing laparoscopic Palomo varicocelectomy using ICG-FL from January 2019 to July 2022, were enrolled. Operative indication was high-grade varicocele in all patients, associated symptoms in 30/72 (41.7 %) and left testicular hypotrophy in 42/72 (58.3 %). Follow-up included clinical examination at 1, 6, 12 months and scrotal Doppler ultrasonography (US) at 12 months postoperatively to assess varicocele persistence, hydrocele, and injections-related complications. RESULTS Lymphatic sparing was achieved using ICG-FL in all cases. No intra-operative complications or adverse reactions secondary to ICG occurred. The median follow-up was 22.8 months (range 11-49). Self-limited scrotal hematoma at the injection site occurred in 1/72 (1.4 %). Intratesticular hypoechoic millimetric area was detected at the injection site in 3/72 (4.2 %) on US. This finding disappeared after 1-year observation in 2/3 cases (66.7 %) (Figure). Persistent grade II varicocele was observed in 4/72 (5.5 %), not requiring re-intervention. No hydrocele occurred and 14/22 (63.6 %) with pre-operative hypotrophy showed catch-up growth. DISCUSSION ICG-FL was clinically safe, with no allergy or systemic adverse reactions to the dye reported in this series. No injury directly related to the injection of the dye was clinically observed, except for self-limiting scrotal hematoma in one patient. A millimetric hypoechoic and avascular area in the body of the left testicle at the injection site was found on scrotal US at 1-year follow-up in 3 patients of our series. This finding does not seem to be clinically relevant as patients were asymptomatic and serum tumor markers were normal in all cases. Furthermore, the hypoechoic area with calcifications resolved 1 year later in 2/3 patients. The absence of evolution of this finding seems to exclude the heteroplastic nature. We hypothesized that this finding may be linked to elevated volume and/or pressure of intratesticular injection. Future prospective study with larger series and longer follow-up is needed to assess long-term testicular outcomes. CONCLUSION Laparoscopic Palomo varicocelectomy using ICG-FL reported excellent outcomes with low incidence of varicocele persistence and no post-operative hydrocele. These preliminary data also confirmed safety of intratesticular injection of ICG at mid-term follow-up, without specific risks for both testis and patient.
Collapse
Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy.
| | - Rachele Borgogni
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Annalisa Chiodi
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Giuseppe Autorino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | | | - Vincenzo Coppola
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Fulvia Del Conte
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Claudia Di Mento
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| |
Collapse
|
2
|
Syarief AN, Rahman IA, Sangadji ARS, Djojodimedjo T, Rizaldi F. A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe? Arch Ital Urol Androl 2023; 95:11627. [PMID: 37791548 DOI: 10.4081/aiua.2023.11627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. METHODS The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. RESULTS A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. CONCLUSIONS AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.
Collapse
Affiliation(s)
- Ahmad Nurfakhri Syarief
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Ilham Akbar Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Agung Ravi Saputra Sangadji
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Tarmono Djojodimedjo
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Fikri Rizaldi
- Department of Urology, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| |
Collapse
|
3
|
Belkovsky M, Passerotti CC, Maximiano LF, Otoch JP, Cruz JASDA. The learning curve of bilateral laparoscopic varicocelectomy: a prospective study. Rev Col Bras Cir 2023; 50:e20233456. [PMID: 37075467 PMCID: PMC10508658 DOI: 10.1590/0100-6991e-20233456-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 04/21/2023] Open
Abstract
Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.
Collapse
Affiliation(s)
- Mikhael Belkovsky
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | | | - Linda Ferreira Maximiano
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
| | - José Pinhata Otoch
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
| | - Jose Arnaldo Shiomi DA Cruz
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| |
Collapse
|
4
|
Indocyanine green fluorescent lymphography during open inguinal hernia repair in a patient who developed postoperative ultrasonic hydrocele: A case report. Int J Surg Case Rep 2021; 90:106691. [PMID: 34972014 PMCID: PMC8717256 DOI: 10.1016/j.ijscr.2021.106691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To our knowledge, no reports of indocyanine green (ICG) fluorescent lymphography during inguinal hernia repair currently exist. We report the case of a patient who underwent ICG fluorescent lymphography during open inguinal hernia repair. CASE PRESENTATION A 63-year-old man was referred to our department for treatment of a right inguinal hernia, during which an ICG lymphography was performed. The patient had a history of robot-assisted radical prostatectomy for prostate cancer. Following induction of general anesthesia, 0.25 mg of ICG was injected into the right testicle and the scrotum was gently massaged, after which an open inguinal hernia repair was performed. During the operation, fluorescence from the ICG was observed in two lymphatic vessels in the spermatic cord. The ICG fluorescent vessels were resected due to the strong adhesion between the lymphatic vessels and the hernia sac. ICG leakage was observed in the resected vessels. An open tension-free technique was performed using an open mesh plug. The patient was discharged one day postoperatively. The histological diagnosis of the resected vessel was a lymphatic vessel. He had a slight postoperative hydrocele that was detected at the follow-up clinic 10 days postoperatively during ultrasonic examination (ultrasonic hydrocele). CONCLUSION We report the use of ICG fluorescent lymphography during open inguinal hernia repair in a patient who developed postoperative ultrasonic hydrocele. This case may indicate a relationship between lymphatic vessel injury and hydrocele.
Collapse
|
5
|
Abstract
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.
Collapse
Affiliation(s)
- Sabine Zundel
- Pediatric Surgery, Children's Hospital Lucerne, 6000 Lucerne 16, Switzerland.
| | - Philipp Szavay
- Pediatric Surgery, Children's Hospital Lucerne, 6000 Lucerne 16, Switzerland
| | - Irina Stanasel
- Pediatric Urology, Children's Health UT Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
6
|
Esposito C, Turrà F, Del Conte F, Izzo S, Gargiulo F, Farina A, Severino G, Cerulo M, Escolino M. Indocyanine Green Fluorescence Lymphography: A New Technique to Perform Lymphatic Sparing Laparoscopic Palomo Varicocelectomy in Children. J Laparoendosc Adv Surg Tech A 2019; 29:564-567. [DOI: 10.1089/lap.2018.0624] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Francesco Turrà
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Fulvia Del Conte
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Serena Izzo
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Francesca Gargiulo
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Alessandra Farina
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Giovanni Severino
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, “Federico II” University of Naples, Naples, Italy
| |
Collapse
|
7
|
Al-Kandari AM, Khudair A, Arafa A, Zanaty F, Ezz A, El-Shazly M. Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis. Arab J Urol 2018; 16:181-187. [PMID: 29713549 PMCID: PMC5922226 DOI: 10.1016/j.aju.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/02/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022] Open
Abstract
Objective 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. Patients and methods 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. Results 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%. Conclusion 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.
Collapse
Affiliation(s)
| | | | | | - Fouad Zanaty
- Department of Urology, Menoufia University, Menofia Governorate, Egypt
| | - Ahmed Ezz
- Department of Urology, Al-Salam Hospital, Kuwait City, Kuwait
| | - Mohamed El-Shazly
- Department of Urology, Menoufia University, Menofia Governorate, Egypt
| |
Collapse
|
8
|
Treatment of varicoceles: techniques and outcomes. Fertil Steril 2017; 108:378-384. [DOI: 10.1016/j.fertnstert.2017.07.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 11/23/2022]
|
9
|
Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 20. Adolescent Varicocele. Pediatr Dev Pathol 2017; 19:360-370. [PMID: 25105427 DOI: 10.2350/14-06-1515-pb.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Varicocele is characterized by elongation, dilatation, and tortuosity of the veins draining the testis and its covers, causing circulatory reflux along the inner spermatic vein [ 1 ]. Varicocele results in progressive testicular lesions and, if untreated, can lead to testicular atrophy [ 2 ]. Varicocele is considered the most frequently identified cause of male infertility [ 3 ]. The mechanisms involved in varicocele formation are not well known and probably are multiple, differing from one patient to another.
Collapse
Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
| |
Collapse
|
10
|
Cullis PS, Gudlaugsdottir K, Andrews J. A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery. PLoS One 2017; 12:e0175213. [PMID: 28384296 PMCID: PMC5383307 DOI: 10.1371/journal.pone.0175213] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify characteristics predictive of review quality. BACKGROUND Systematic reviews summarise evidence by combining sources, but are potentially prone to bias. To counter this, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was published to aid in reporting. Similarly, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) measurement tool was designed to appraise methodology. The paediatric surgical literature has seen an increasing number of reviews over the past decade, but quality has not been evaluated. METHODS Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify systematic reviews and meta-analyses of interventions in paediatric surgery. From 01/2010 to 06/2016, we searched: MEDLINE, EMBASE, Cochrane, Centre for Reviews and Dissemination, Web of Science, Google Scholar, reference lists and journals. Two reviewers independently selected studies and extracted data. We assessed conduct and reporting using AMSTAR and PRISMA. Scores were calculated as the sum of reported items. We also extracted author, journal and article characteristics, and used them in exploratory analysis to determine which variables predict quality. RESULTS 112 articles fulfilled eligibility criteria (53 systematic reviews; 59 meta-analyses). Overall, 68% AMSTAR and 56.8% PRISMA items were reported adequately. Poorest scores were identified with regards a priori design, inclusion of structured summaries, including the grey literature, citing excluded articles and evaluating bias. 13 reviews were pre-registered and 6 in PRISMA-endorsing journals. The following predicted quality in univariate analysis:, word count, Cochrane review, journal h-index, impact factor, journal endorses PRISMA, PRISMA adherence suggested in author guidance, article mentions PRISMA, review includes comparison of interventions and review registration. The latter three variables were significant in multivariate regression. CONCLUSIONS There are gaps in the conduct and reporting of systematic reviews in paediatric surgery. More endorsement by journals of the PRISMA guideline may improve review quality, and the dissemination of reliable evidence to paediatric clinicians.
Collapse
Affiliation(s)
- Paul Stephen Cullis
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Katrin Gudlaugsdottir
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - James Andrews
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
11
|
Guo LQ, Zhang XL, Liu YQ, Sun WD, Zhao ST, Yuan MZ. The application of laparoscopic Doppler ultrasound during laparoscopic varicocelectomy in infertile men. Asian J Androl 2017; 19:214-218. [PMID: 27678469 PMCID: PMC5312221 DOI: 10.4103/1008-682x.189622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study is to evaluate the benefits of laparoscopic Doppler ultrasound (LDU) application during laparoscopic varicocelectomy (LV), and to compare the surgical outcomes and complications between LDU-assisted LV (LDU-LV) and conventional LV for infertile patients with varicoceles; 147 infertile patients were randomly divided into two groups. Operative and postoperative parameters, semen parameters, and the pregnancy rate were compared. There were no differences in baseline demographics. The operative time was significantly longer in LDU-LV group than LV group. The incidence of postoperative hydrocele was 1.4% (1/72) in LDU-LV group versus 10.7% (8/75) in LV group, which showed a significant difference (P < 0.05). However, other surgical outcomes, such as postoperative hospital stay, postoperative recurrence, and testicular atrophy, were similar between the two groups. Sperm concentration and sperm motility were significantly increased in both groups at 3, 6, and 12 months after surgery (P < 0.01), and they were higher in LDU-LV than LV group in 12 months after surgery (34.21 ± 6.36 vs 29.99 ± 6.04 for concentration, P < 0.05; 40.72 ± 8.12 vs 37.31 ± 6.12 for motility, P < 0.05). Sperm morphology was comparable between the two groups. The pregnancy rate showed no significant difference (44.4% of the LDU-LV vs 37.3% of the LV, P > 0.05). In conclusion, compared with LV, LDU-LV could safely and effectively ligate all spermatic veins and preserve spermatic arteries without leading to high varicocele recurrence and postoperative hydrocele. Given the benefits that sperm counts as well as sperm motility favoring LDU-LV, we recommend that LDU should be routinely used as an effective tool to improve outcomes and safety of laparoscopic varicocelectomy.
Collapse
Affiliation(s)
- Li-Qiang Guo
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Xiu-Lin Zhang
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Yu-Qiang Liu
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China.,Institute of Urology, Shandong University, Jinan, Shandong 250033, China
| | - Wen-Dong Sun
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| | - Sheng-Tian Zhao
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China.,Institute of Urology, Shandong University, Jinan, Shandong 250033, China
| | - Ming-Zhen Yuan
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong 250033, China
| |
Collapse
|
12
|
Wang J, Xia SJ, Liu ZH, Tao L, Ge JF, Xu CM, Qiu JX. Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis. Asian J Androl 2016; 17:74-80. [PMID: 25248652 PMCID: PMC4291882 DOI: 10.4103/1008-682x.136443] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles: laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy (no treatment). Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates (odds ratio (OR): 3.48, 2.68, 2.92 and 2.90, respectively). Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density (mean difference (MD): 10.60, 95% confidence interval (CI): 1.92–19.60) and sperm motility (MD: 9.09, 95% CI: 4.88–13.30). Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence (OR: 0.05, 0.06 respectively). Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery (OR = 0.07, 95% CI: 0.02–0.19), followed by subinguinal microsurgery (OR = 0.09, 95% CI: 0.02–0.19). Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jian-Xin Qiu
- Department of Urology, Shanghai First People's Hospital, Medical College of Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
13
|
Qi X, Wang K, Zhou G, Xu Z, Yu J, Zhang W. The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis. Int Urol Nephrol 2016; 48:955-65. [PMID: 26971102 DOI: 10.1007/s11255-016-1254-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy. METHODS All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0. RESULTS A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83-4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08-0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17-2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86-1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09-1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65-1.40; P = 0.809). CONCLUSION With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.
Collapse
Affiliation(s)
- Xiaokang Qi
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Kunpeng Wang
- Department of Urology, The First People's Hospital of Lianyungang City, No. 182 North Tongguan Road, Xinpu District, Lianyungang, 222002, Jiangsu, China
| | - Guangchen Zhou
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Zhen Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Junjie Yu
- Department of Urology, Subei People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| |
Collapse
|
14
|
Yu W, Rao T, Ruan Y, Yuan R, Cheng F. Laparoscopic Varicocelectomy in Adolescents: Artery Ligation and Artery Preservation. Urology 2016; 89:150-4. [DOI: 10.1016/j.urology.2015.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/06/2015] [Accepted: 11/27/2015] [Indexed: 11/17/2022]
|
15
|
Abstract
Adolescent varicocele is associated with ipsilateral testicular hypotrophy and the concern for future infertility. A testicular size discrepancy greater than 15-20 % between left and right testicle is an indication for treatment to allow catch-up growth in the hope of preventing a future decline in fertility. Some authors advocate for a period of watchful waiting, as normal testicular growth may occur asymmetrically. We review the current literature to highlight some controversies and challenges in management.
Collapse
Affiliation(s)
- Michael L Garcia-Roig
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, 5445 Meridian Mark Rd, Suite 420, Atlanta, GA, 30342, USA
| | | |
Collapse
|
16
|
Nork JJ, Berger JH, Crain DS, Christman MS. Youth varicocele and varicocele treatment: a meta-analysis of semen outcomes. Fertil Steril 2014; 102:381-387.e6. [DOI: 10.1016/j.fertnstert.2014.04.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
|
17
|
Zheng XD, Li D, Yang DH, Xiang X, Mei H, Pu JR, Tong QS, Zheng LD. Association of Ureaplasma urealyticum colonization with development of bronchopulmonary dysplasia: a systemic review and meta-analysis. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2014; 34:265-269. [PMID: 24710943 DOI: 10.1007/s11596-014-1269-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/02/2013] [Indexed: 11/28/2022]
Abstract
There is controversy regarding the roles of Ureaplasma urealyticum (U. urealyticum) colonization in the development of bronchopulmonary dysplasia (BPD). This study explored the association between U. urealyticum and bronchopulmonary dysplasia at 36 weeks post-menstrual age (BPD36). Studies published before December 31, 2013 were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases, with the terms "Ureaplasma urealyticum", "chronic lung disease", or "BPD36" used, and English language as a limit. The association between U. urealyticum colonization and BPD36 was analyzed with RevMan 4.2.10 software, using the odds ratio (OR) and relative risk (RR) for dichotomous variables. Out of the enrolled 81 studies, 11 investigated the BPD36 in total 1193 infants. Pooled studies showed no association between U. urealyticum colonization and subsequent development of BPD36, with the OR and RR being 1.03 (95% CI=0.78-1.37; P=0.84) and 1.01 (95% CI= 0.88-1.16, P=0.84), respectively. These findings indicated no association between U. urealyticum colonization and the development of BPD36.
Collapse
Affiliation(s)
- Xiao-Dan Zheng
- Department of Stomatology, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Dan Li
- Department of Pediatric Surgery, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - De-Hua Yang
- Department of Pediatric Surgery, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuan Xiang
- Department of Pediatric Surgery, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hong Mei
- Department of Pediatric Surgery, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jia-Rui Pu
- Department of Pediatric Surgery, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qiang-Song Tong
- Department of Pediatric Surgery, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li-Duan Zheng
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
18
|
Esposito C, Iaquinto M, Escolino M, Cortese G, De Pascale T, Chiarenza F, Cerulo M, Settimi A. Technical standardization of laparoscopic lymphatic sparing varicocelectomy in children using isosulfan blue. J Pediatr Surg 2014; 49:660-3. [PMID: 24726132 DOI: 10.1016/j.jpedsurg.2013.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/07/2013] [Accepted: 12/11/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The lymphatic preservation to prevent hydrocele formation after laparoscopic varicocelectomy is essential. Lymphatic sparing procedures using scrotal injection give a rate of mapping failures of 20%-30%. The aim of the present study is to standardize the technique of injection to perform a lymphatic sparing procedure in case of laparoscopic varicocelectomy. METHODS We retrospectively evaluated 50 patients who underwent laparoscopic varicocelectomy from July 2010 to July 2013. Patients were divided into two groups: G1 (25 patients) those who underwent a classical isosulfan blue scrotal intra-dartos injection and G2 (25 patients) those who underwent the new standardized isosulfan blue scrotal intra-dartos/intra-testicular injection. RESULTS In G1 lymphatic vessels were identified as blue coloured in 19/25 of cases (76%), in G2 in 25/25 of cases (100%). The results were analyzed using test χ(2) with Yates' correction and there was a statistically significant difference (χ(2)=0.05,1) between G2 and G1. Postoperative hydrocele was noted in 2/6 patients of G1 in whom the lymphatic vessels were not identified. CONCLUSIONS Laparoscopic lymphatic sparing varicocelectomy is an effective procedure to adopt in children with varicocele. The intra-dartos/intra-testicular injection of isosulfan blue is significantly better than the previously described intra-dartos injection, permitting to identify lymphatic vessels in 100% of cases in our series. No allergy to isosulfan blue was reported in both groups.
Collapse
Affiliation(s)
- Ciro Esposito
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy.
| | - Marianna Iaquinto
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Maria Escolino
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Giuseppe Cortese
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Teresa De Pascale
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Mariapina Cerulo
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Medical Translational Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| |
Collapse
|
19
|
Chiarenza SF, Giurin I, Costa L, Alicchio F, Carabaich A, De Pascale T, Settimi A, Esposito C. Blue patent lymphography prevents hydrocele after laparoscopic varicocelectomy: 10 years of experience. J Laparoendosc Adv Surg Tech A 2012; 22:930-3. [PMID: 23074989 DOI: 10.1089/lap.2012.0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Laparoscopic varicocelectomy according to the Palomo technique is the most common procedure adopted in children with testicular varicocele. This procedure involves the ligation of the internal spermatic cord and is associated with a 3%-5% incidence of recurrence and up to 30% incidence of hydroceles. We sought to determine the impact of lymphatic preservation on hydrocele formation and the success of varicocelectomy. PATIENTS AND METHODS We retrospectively evaluated 396 patients with a mean age of 13.2 years who underwent laparoscopic varicocelectomy. Patients were divided into two groups: those who underwent a lymphatic-sparing (LS) procedure using isosulfan blue scrotal intra-dartoic injection and those who underwent a non-LS (NLS) technique. The incidences of recurrence/persistence and postoperative hydrocele formation requiring surgery or aspiration were analyzed statistically using the chi-squared test. RESULTS Of 396 patients, 244 received a laparoscopic LS procedure, and 152 received an NLS operation. The LS patients in whom the lymphatic vessels were not identified (26/244 [10.6%]) were considered NLS repairs. The follow-up was at least 12 months. LS surgery (218 patients) was associated with a decreased incidence of postoperative hydrocele (0/218 [0%] versus 18/178 [10.1%]; chi-squared test=25.84, difference statistically significant). There was no significant difference in incidence of persistent or recurrent varicocele requiring reoperation following the initial procedure (5/218 [2.2%] versus 5/178 [2.8%]; chi-squared test=0.41, difference statistically not significant). CONCLUSIONS Laparoscopic LS varicocelectomy using isosulfan blue is preferable to laparoscopic Palomo repair that does not preserve the lymphatics. It has a significantly lower incidence of postoperative hydroceles and still maintains a low incidence of persistence/recurrence.
Collapse
|
20
|
Niyogi A, Singh S, Zaman A, Khan A, Nicoara C, Haddad M, Madden N, Clarke SA, Mathur A, Tsang T, Kulkarni M, Minocha A, DeCaluwé D. Varicocele surgery: 10 years of experience in two pediatric surgical centers. J Laparoendosc Adv Surg Tech A 2012; 22:521-5. [PMID: 22568541 DOI: 10.1089/lap.2011.0531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The study was designed to compare recurrence rates and complications after laparoscopic versus open varicocele surgery in children. SUBJECTS AND METHODS A retrospective case-note review of all varicocele surgery over a 10-year period (April 1999-March 2009) in two pediatric surgical centers was performed. Multivariate analysis using logistic regression was performed using SPSS Statistics version 18 (SPSS Inc., Chicago, IL). RESULTS Thirty-seven patients had varicocele surgery during the study period. The median age at surgery was 14 years (range, 11-16 years). Most children had left-sided Grade 2 varicocele. Twenty-five (68%) primary procedures were laparoscopic (17 artery-sparing), and 12 (32%) procedures were open (9 artery-sparing). Six (16%) children had recurrence, and 6 (16%) had postoperative hydrocele. Recurrence rates after laparoscopic (16%) and open (17%) surgery were similar. Increasing age significantly decreased recurrence (odds ratio, 0.373; 95% confidence interval 0.161-0.862; P = .021). Although laparoscopy was associated with higher rates of postoperative hydrocele (odds ratio, 2.817; 95% confidence interval, 0.035-3.595; P = .380) and artery-sparing ligation was associated with higher rates of recurrence (odds ratio, 2.667; 95% confidence interval, 0.022-4.235; P = .787), these associations were not statistically significant. CONCLUSIONS The best results of varicocele surgery in terms of recurrence and postoperative hydrocele were achieved by open mass ligation; however, larger prospective studies are warranted.
Collapse
Affiliation(s)
- Anindya Niyogi
- Chelsea and Westminster Hospital, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|