title: Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns.
abstract: OBJECTIVE
  To investigate different varicocele hemodynamic patterns (shunt type vs. stop type) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Department of pediatric urology, children's hospital medical center.
  
  
  METHODS
  Seventy-four children and adolescents with varicocele.
  
  
  METHODS
  Based on ultrasound findings, patients were classified into shunt-type or stop-type varicocele groups. All patients with stop-type varicocele and testicular volume discrepancy of ≥20% underwent retroperitoneal varicocelectomy and internal spermatic vein ligation. Patients with shunt-type varicocele and ≥20% testicular asymmetry were randomly divided to undergo either retroperitoneal varicocelectomy (ligation of internal spermatic vein) or inguinal varicocelectomy with ligation of both internal and external spermatic veins. Patients with testicular volume discrepancy of <20% were put on conservative management.
  
  
  METHODS
  Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients.
  
  
  RESULTS
  Patients with shunt-type varicocele who did not undergo surgery revealed a higher risk of developing asymmetry during follow-up (odds ratio 10.5). Ligation of both internal and external spermatic veins in shunt-type patients was associated with significantly decreased rate of recurrence (6.3%) compared with retroperitoneal approach (30.8%).
  
  
  CONCLUSIONS
  Shunt-type varicocele is associated with a higher risk of testicular hypotrophy among untreated patients. In addition, recurrence rate in shunt-type patients who underwent inguinal varicocelectomy was lower compared with retroperitoneal approach.
authors.affiliation: Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Javad
authors.initials: MJ
authors.lastname: Mohseni
authors.forename: Hamid
authors.initials: H
authors.lastname: Nazari
authors.forename: Erfan
authors.initials: E
authors.lastname: Amini
authors.forename: Niloufar
authors.initials: N
authors.lastname: Javan-Farazmand
authors.forename: Arash
authors.initials: A
authors.lastname: Baghayee
authors.forename: Hossein
authors.initials: H
authors.lastname: Farzi
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D001284:Atrophy; D002648:Child; D018450:Disease Progression; D006439:Hemodynamics; D006776:Hospitals, Pediatric; D006801:Humans; D007492:Iran; D008026:Ligation; D008297:Male; D016017:Odds Ratio; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013733:Testicular Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013737:Testis / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D013521:Urologic Surgical Procedures, Male; D014646:Varicocele / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery