Adolescent Varicocele; In Whom? How? Why The Approach?

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 25 May 2008 - 0:00 PDT

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UroToday.com - Dr Israel Franco, Associate Professor of Urology, New York Medical College reviewed the pediatric urology literature focusing on the issues of : progressive testicular injury, the significance of hyotrophy, and rebound testicular growth. He followed with a review of the approaches that have been taken by the pediatric urologist to repair the varicocele. These included retrograde and antegrade sclerotherapy, inguinal and retroperitoneal techniques and laparoscopic techniques. The risks and complications of each were reviewed.

The conclusions of his analysis were:

1. The prepubertal varicocele is uncommon

2. Ipsilateral hypotrophy of greater than 10% may be an appropriate indication for varicocelectomy. Hypotrophy of greater than 20% is a clear indication.

3. Catch up growth after surgery is a positive outcome

4. Surgery should be preformed utilizing a lymphatic sparing technique whether this approach is laparoscopic or open, whether it be retroperitoneal or inguinal.

5. The benefit or risks of Palomo mass ligation technique versus testicular artery approaches requires further study.

6. Parental concern regarding the child's future fertility is perhaps one of the most significant indicators for adolescent varicocelectomy.

Presented by Israel Franco, MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Harris M. Nagler, MD

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