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Tandon S, Bennett D, Mark Nataraja R, Pacilli M. Outcome following the surgical management of varicocele in children and adolescents: a systematic review and meta-analysis. Ther Adv Urol 2023; 15:17562872231206239. [PMID: 37868369 PMCID: PMC10590051 DOI: 10.1177/17562872231206239] [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: 04/04/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background The ideal surgical approach for the management of varicocele in children and adolescents remains controversial. Several techniques are available including artery- or lymphatic-sparing with optical magnification (via open inguinal or sub-inguinal approach), laparoscopic, antegrade and retrograde embolization/sclerotherapy. Objectives We aimed to appraise the clinical outcomes of these techniques in children and adolescents. Data Sources and Methods A systematic review was conducted (1997-2023). Meta-analysis or proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results are expressed as overall proportion % and 95% confidence interval (CI). Results We identified 1910 studies; 632 duplicates were removed, 1278 were screened, 203 were reviewed and 56 were included, with 12 reporting on 2 different techniques (total of 68 data sets). Optical magnification via inguinal approach (498 cases): recurrence 2.5% (0.6-5.6), hydrocele 1.6% (0.47-3.4), testicular atrophy 1% (0.3-2.0), complications 1.1% (0.2-2.6); optical magnification via sub-inguinal approach (592 cases): recurrence 2.1% (0.7-4.4), hydrocele 1.26% (0.5-2.3), testicular atrophy 0.5% (0.1-1.3), complications 4% (1.0-8.8). Laparoscopic with mass-ligation/division (1943 cases): recurrence 2.9% (1.5-4.6), hydrocele 11.4% (8.3-14.9); complications 1.5% (0.6-2.9); laparoscopic with lymphatic-sparing (974 cases): recurrence 2.4% (1.5-3.5), hydrocele 1.2% (0.45-3.36), complications 1.2% (0.05-3.9); laparoscopic with artery-sparing (228 cases): recurrence 6.6% (2.3-12.9), hydrocele 6.5% (2.6-12.0). Antegrade embolization/sclerotherapy (403 cases): recurrence 7.6% (5.2-10.4), hydrocele 0.8% (0.17-1.9), technical failure 0.6% (0.1-1.6), complications 4.0% (2.3-6.1); retrograde embolization/sclerotherapy (509 cases): recurrence 6.9% (4.6-9.5), hydrocele 0.8% (0.05-2.5), technical failure 10.2% (4.6-17.6), and complications 4.8% (1.0-11.2). Conclusion The recurrence rate varies between 2.1% and 7.6% and is higher with the embolization/sclerotherapy techniques. Post-operative hydrocele rate varies between 0.8% and 11.4% and is higher with the laparoscopic mass-ligation/division technique. Testicular atrophy has not been reported with the laparoscopic and embolization/sclerotherapy techniques. The retrograde embolization technique is associated with 10% technical failure (inability to complete the procedure). The laparoscopic lymphatic-sparing technique is characterized by the lowest recurrence rate, incidence of hydrocele and other complications, and no reports of testicular atrophy.
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Affiliation(s)
- Sarthak Tandon
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| | - Daniel Bennett
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Level 5, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Pensabene M, Di Pace MR, Baldanza F, Sergio M, Cimador M. A Comprehensive Ultrasonographic Assessment of Pediatric and Adolescent Varicocele Can Improve Surgical Results. Urol Int 2020; 104:884-890. [PMID: 32894858 DOI: 10.1159/000510123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Undetected refluxing venous systems could cause persistence/recurrence of varicoceles in patients undergoing varicocelectomy. Color Doppler ultrasound (CDUS) is an important tool in the diagnosis and follow-up of varicocele, and could be successfully used to detect a venous reflux in the iliac-deferential district, usually involved in the recurrence/persistence of varicocele. MATERIALS AND METHODS We compared 2 historical series of patients treated with Palomo laparoscopic varicocelectomy between 1994 and 2018. In group 1, preoperative scrotal CDUS was obtained, while in group 2, additional inguinal CDUS was performed in order to detect a refluxing deferential vein (DV). When a deferential reflux was found, the DV and internal spermatic vein were interrupted during the same Palomo laparoscopic varicocelectomy. RESULTS A total of 449 patients underwent left laparoscopic varicocelectomy; 146 of them were not studied for deferential reflux with CDUS (group 1), while in the remaining 303, routine CDUS research of deferential reflux was obtained (group 2). The persistence/recurrence rate was significantly higher in group 1 (13.7 vs. 1%, p < 0.000). CONCLUSIONS The research of a refluxing DV revealed a useful, cost-effective, and simple tool, allowing a better comprehension of the vascular anatomy of varicocele and, thus, a significant reduction of varicocele persistence/recurrence rate.
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Affiliation(s)
- Marco Pensabene
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy,
| | - Maria Rita Di Pace
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
| | - Fabio Baldanza
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
| | - Maria Sergio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
| | - Marcello Cimador
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
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Silay MS, Hoen L, Quadackaers J, Undre S, Bogaert G, Dogan HS, Kocvara R, Nijman RJM, Radmayr C, Tekgul S, Stein R. Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol 2018; 75:448-461. [PMID: 30316583 DOI: 10.1016/j.eururo.2018.09.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT The benefits and harms of intervention (surgical or radiological) versus observation in children and adolescents with varicocele are controversial. OBJECTIVE To systematically evaluate the evidence regarding the short- and long-term outcomes of varicocele treatment in children and adolescents. EVIDENCE ACQUISITION A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A priori protocol was registered to PROSPERO (CRD42018084871), and a literature search was performed for all relevant publications published from January 1980 until June 2017. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 50 participants were eligible for inclusion. EVIDENCE SYNTHESIS Of 1550 articles identified, 98 articles including 16 130 patients (7-21 yr old) were eligible for inclusion (12 RCTs, 47 NRSs, and 39 case series). Varicocele treatment improved testicular volume (mean difference 1.52ml, 95% confidence interval [CI] 0.73-2.31) and increased total sperm concentration (mean difference 25.54, 95% CI 12.84-38.25) when compared with observation. Open surgery and laparoscopy may have similar treatment success. A significant decrease in hydrocele formation was observed in lymphatic sparing versus non-lymphatic sparing surgery (p=0.02). Our findings are limited by the heterogeneity of the published data, and a lack of long-term outcomes demonstrating sperm parameters and paternity rates. CONCLUSIONS Moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration. Current evidence does not demonstrate superiority of any of the surgical/interventional techniques regarding treatment success. Long-term outcomes including paternity and fertility still remain unknown. PATIENT SUMMARY In this paper, we review benefits and harms of varicocele treatment in children and adolescents. We found moderate evidence that varicocele treatment results in improvement of testicular volume and sperm concentration. Lymphatic sparing surgery decreases hydrocele formation. Paternity and fertility outcomes are not clear.
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Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Lisette Hoen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Josine Quadackaers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Shabnam Undre
- Department of Pediatric and Adult Urology, East and North Herts NHS Trust, Stevenage, UK
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Radim Kocvara
- Department of Urology, General Teaching Hospital and Charles University 1st Faculty of Medicine in Praha, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Esposito C, Escolino M, Castagnetti M, Cerulo M, Settimi A, Cortese G, Turrà F, Iannazzone M, Izzo S, Servillo G. Two decades of experience with laparoscopic varicocele repair in children: Standardizing the technique. J Pediatr Urol 2018; 14:10.e1-10.e7. [PMID: 28807743 DOI: 10.1016/j.jpurol.2017.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 06/28/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Controversy still exists about the indications and the gold standard approach for varicocele treatment in pediatric population. OBJECTIVE The authors report their 23 years of experience in laparoscopic varicocele repair in the pediatric population. STUDY DESIGN We retrospectively evaluated the data of 345 consecutive patients who underwent laparoscopic left varicocelectomy from January 1993 to December 2015. Average patient age was 12.5 years (range 8-17). Seven out of 345 patients (2%) had a recurrent varicocele, and five out of 345 patients (1.4%) had a varicocele on a single testis. In 335/345 patients (97.1%) we performed a Palomo procedure, and in 10/345 patients (2.9%) an artery-sparing Palomo procedure. After 2010, in 105/345 patients (30.4%) we performed a lymphatic sparing procedure using isosulfan blue injection preoperatively. RESULTS All procedures were completed in laparoscopy (Figure), without conversions or intraoperative complications. The average operative time was 17 min (range 14-45) for the Palomo procedure and 26 min (range 18-50) for artery-sparing Palomo. In 45/345 patients (13%) we performed additional procedures. We recorded 4/345 (1.3%) recurrences/persistences in patients undergoing Palomo, while we recorded 1/10 (10%) recurrence/persistence after artery-sparing Palomo. On 230 Palomo procedures performed in the pre-isosulfan blue era, we recorded 25 cases of hydrocele (10.8%), 13 of these were treated with transcrotal puncture and 12 required surgical operation. The last 105 patients undergoing isosulfan blue injection had no postoperative hydrocele. We also reported 10 other complications (I grade Clavien-Dindo) such as umbilical granuloma or instrumental problems. DISCUSSION Analyzing the international literature of the last 25 years, most papers focused on the minimally invasive treatment of pediatric varicocele. There are several reasons to perform laparoscopic repair of pediatric varicocele. First of all, it is technically easy to perform, the average operative time is very short, and it has excellent outcome in regard to varicocele persistence/recurrence. In addition it has a very low complication rate, and in particular adopting the intradartoic/intratesticular isosulfan blue injection before surgery we recorded no postoperative hydrocele. CONCLUSION On the basis of our 23 years of experience with varicocele repair, we clearly believe that laparoscopic Palomo lymphatic sparing varicocelectomy should be considered the standard of care for the treatment of pediatric patients with varicocele. Laparoscopic varicocelectomy is technically easy and quick to perform, painless, and scarless, with a recurrence rate of about 1%. The use of a preoperative injection of isosulfan blue completely eliminates postoperative hydrocele formation.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
| | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Mariapina Cerulo
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Cortese
- Department of Anesthesiology, Federico II University of Naples, Naples, Italy
| | - Francesco Turrà
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Marta Iannazzone
- Department of Anesthesiology, Federico II University of Naples, Naples, Italy
| | - Serena Izzo
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Anesthesiology, Federico II University of Naples, Naples, Italy
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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.
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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
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Parrilli A, Roberti A, Escolino M, Esposito C. Surgical approaches for varicocele in pediatric patient. Transl Pediatr 2016; 5:227-232. [PMID: 27867844 PMCID: PMC5107384 DOI: 10.21037/tp.2016.09.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Varicocele represents one of the most common surgically correctible urologic anomalies in adolescent males. The best procedure for the treatment of adolescent varicocele has not been established, but with recent advances in minimal access surgery, there have been many reports praising the safety and efficacy of laparoscopy and retroperitoneoscopy for the surgical correction of varicocele in adolescent. The aim of this review is to compare the results of Palomo's technique, with retroperitoneoscopic and transperitoneoscopic approaches in adolescent, analyzing recurrence, testicular growth and complications. METHODS A literature search on PubMed and Cochrane Database was conducted with regard to management of varicocele in adolescent population. Twenty two English language studies that compared outcome of different minimally invasive treatments or outcome of minimally invasive and traditional surgical treatments for adolescent diagnosed with varicocele were included. RESULTS Intraoperative complications of minimally invasive approaches occur in early cases, but in pediatric urology these procedures would become more efficient with experience and these approaches continue to increase in number. Postoperative hydrocele is the most postoperative compliance of Palom technique, and reports have shown a wide range of variability for his incidence, depending on the technique used for surgical treatment. Literature showed an increase of testicular volume for real growth of testis after surgery, and an intratesticular improvement in sperm quality after minimally invasive approach. In laparoscopic approach reports have showed very low recurrence because allows better vision of collateral veins, and a lymphatic sparing technique permit to identify lymphatic vessels in 100% of cases. CONCLUSIONS The literature has shown that laparoscopic varicocelectomy is the surgical approach most commonly reported in adolescent patients, and that its use is increasing for better training for surgeons and the ability to avoid operational hydrocele that is a main complication after technical Palomo's technique.
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Affiliation(s)
- Alejandra Parrilli
- Department of Pediatric Surgery, University of Caracas, Caracas, Venezuela
| | - Agnese Roberti
- Department of Translational Medical Sciences, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
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Camoglio FS, Zampieri N. Varicocele treatment in paediatric age: relationship between type of vein reflux, surgical technique used and outcomes. Andrologia 2015; 48:389-92. [DOI: 10.1111/and.12458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- F. S. Camoglio
- Department of Surgical Sciences; Pediatric Surgical Unit; Policlinico ‘G.B.Rossi’; University of Verona; Verona Italy
| | - N. Zampieri
- Department of Surgical Sciences; Pediatric Surgical Unit; Policlinico ‘G.B.Rossi’; University of Verona; Verona Italy
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Mancini S, Bulotta AL, Molinaro F, Ferrara F, Tommasino G, Messina M. Surgical retroperitoneoscopic and transperitoneoscopic access in varicocelectomy: duplex scan results in pediatric population. J Pediatr Urol 2014; 10:1037-42. [PMID: 24786532 DOI: 10.1016/j.jpurol.2014.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This is a retrospective study to compare duplex scan results of laparoscopic Palomo's technique through retroperitoneal and transperitoneal approach for varicocelectomy in children. We statistically analyzed recurrence, testicular volume growth and complications. PATIENTS AND METHODS Surgical intervention was performed utilizing transperitoneoscopic (group A) or retroperitoneoscopic access (group B). Duplex scan control was performed after 12 months (T1), after 2 years (T2) and the last one at 18 years old in most patients. Statistical analysis was performed using the t-test for parametric data. Differences in proportions were evaluated using χ2 or Fisher's exact test. RESULTS We treated 120 children (age range 10-17 years) who presented an asymptomatic IV grade of reflux, Coolsaet 1, associated with a left testicular hypotrophy in 36.6% of the cases (44 patients). No post-operative complications were verified. Duplex scan exam showed an increase of left testicular growth in both groups, with complete hypotrophy disappear in patients in both groups after 24 months. Hydrocele, diagnosed clinically and confirmed with duplex scan, was the most frequent post-operative complication (22/120 cases; 18.3%). CONCLUSIONS This study showed the importance of duplex scan at all steps of this vascular pathology in children, and that there is no significantly difference in results between the two surgical techniques except for hydrocele in transperitoneoscopic access.
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Affiliation(s)
- Stefano Mancini
- Section of Phlebology, Department of General and Specialistic Surgery, University of Siena, 53100 Siena, Italy
| | - Anna Lavinia Bulotta
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy.
| | - Francesco Molinaro
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
| | - Francesco Ferrara
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
| | - Giulio Tommasino
- Section of Phlebology, Department of General and Specialistic Surgery, University of Siena, 53100 Siena, Italy
| | - Mario Messina
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
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Zampieri N, Zampieri G, Antonello L, Camoglio FS. Trans-scrotal varicocelectomy in adolescents: clinical and surgical outcomes. J Pediatr Surg 2014; 49:583-5. [PMID: 24726117 DOI: 10.1016/j.jpedsurg.2013.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/26/2013] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The gold standard to treat varicocele in adolescents is still under discussion. The aim of this study is to evaluate the role of trans-scrotal varicocelectomy and show the results obtained by using local anesthesia in combination with preoperative sedation. MATERIALS AND METHODS Between January 2010 and January 2012, this surgical and anesthesiology procedure was proposed to study patients. Inclusion and exclusion criteria were created. Patients received trans-scrotal varicocelectomy with lymphatic and artery sparing technique under local anesthesia with mild sedation anesthesia. Patients were followed for 6 months after surgery, and complications were recorded. RESULTS Eighteen patients were treated with this technique. Three patients required additional sedation with propofol. None had recurrence of varicocele, and one patient showed post-operative hydrocele. All patients were discharged within 24h following surgery. Three patients used ibuprofen and paracetamol for two days after surgery. CONCLUSIONS Local anesthesia in the pediatric age group could be used for varicocelectomy with mild sedation anesthesia.
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Affiliation(s)
- Nicola Zampieri
- Casa di Cura "San Francesco" Hospital, Department of Surgery, via monte Ortigara 21/b, 37100, Verona, Italy.
| | - Gianfranco Zampieri
- Casa di Cura "San Francesco" Hospital, Department of Surgery, via monte Ortigara 21/b, 37100, Verona, Italy
| | - Lucio Antonello
- Department of Anesthesiology; Policlinico "G.B.Rossi", piazzale Scuro n. 1-Verona, Italy
| | - Francesco Saverio Camoglio
- Department of Surgical Sciences, Pediatric Surgical Unit, Policlinico "G.B.Rossi", piazzale Scuron. 1-Verona University of Verona, Verona, Italy
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