Evolving management of adolescent varicocele.
OBJECTIVE
To review the evolution in indications for treatment and treatment modalities for adolescent varicocele at our centre, and evaluate the impact of varicocelectomy on final outcome.


METHODS
Between 1995 and 2006, we treated 242 left varicoceles. Preoperative assessment included clinical evaluation, measurement of testicular volumes, and colour-Doppler ultrasound (CDUS). A subinguinal varicocelectomy was performed in 124 patients (group A), and a laparoscopic non-artery-sparing Palomo procedure in the remaining 118 (group B). In group B patients, CDUS was also used to investigate the functional anatomy of varicocele, and all the veins found to be refluxing were divided during surgery. The two groups were compared with regard to indications for surgery and outcome.


RESULTS
Over time the proportion of patients operated on because of testicular growth retardation increased. Persistence/recurrence rate was comparable between the two groups. In 13% of group B patients, the deferential vein was found to be refluxing on preoperative CDUS and was divided at surgery. Hydrocele rate was higher in group A, unless the vaginalis was excised and everted during varicocelectomy. About 75% of patients with preoperative left testicular growth failure experienced postoperative catch-up growth, irrespective of treatment.


CONCLUSIONS
Indications for treatment are still evolving. Varicocele can successfully be treated in the majority of cases by either a laparoscopic or subinguinal approach. Both techniques require care, and CDUS can aid in the decision making. Most patients with preoperative testicular growth failure experience postoperative catch-up growth.
Castagnetti
Marco
M
Department of Paediatric Surgery, University of Palermo, Dipartimento Universitario Materno Infantile, Via Ugo Betti 46, 90147 Palermo, Italy. marcocastagnetti@hotmail.com
Cimador
Marcello
M
Catalano
Pieralba
P
DiPace
MariaRita
M
Sergio
Maria
M
De Grazia
Enrico
E
D000293:Adolescent; D002648:Child; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D013737:Testis / Q000000981:diagnostic imaging / Q000254:growth & development*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*