Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns. Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. Effects of varicocelectomy on testis volume and semen parameters in adolescents: a randomized prospective study. Sperm chromatin condensation in infertile men with varicocele before and after surgical repair. [Transumbilical single-site single-port versus single-site double-port laparoscopic varicocelectomy for varicocele in adolescents]. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele. Expression of the HSPA2 gene in ejaculated spermatozoa from adolescents with and without varicocele. Diagnosis of Pediatric Varicoceles by Physical Examination and Ultrasonography and Measurement of the Testicular Volume Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Effects of supplement therapy on sperm parameters, protamine content and acrosomal integrity of varicocelectomized subjects Varicocele treatment in pubertal boys prevents testicular growth arrest. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Repair versus observation in adolescent varicocele: a prospective study. Effects of varicocele on serum testosterone and changes of testosterone after varicocelectomy: a prospective controlled study. Comparison of bilateral versus unilateral varicocelectomy in men with palpable bilateral varicoceles. Dye-assisted lymph vessels sparing laparoscopic varicocelectomy. Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate. The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study. Laparoscopic versus Open High Ligation of the Testicular Veins for the Treatment of Varicocele Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. Effect of microsurgical subinguinal varicocele ligation to treat pain.
OBJECTIVE To investigate different varicocele hemodynamic patterns ( shunt type vs. stop type ) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy . DESIGN Prospect i ve clinical study . SETTING Department of pediatric urology , children 's hospital medical center . PATIENT(S ) Seventy-four children and adolescents with varicocele . INTERVENTION(S ) 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 r and omly 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 . MAIN OUTCOME MEASURE(S ) Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients . RESULT ( S ) 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 % ) . CONCLUSION ( S ) 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 To evaluate , in a r and omized prospect i ve trial in children and adolescents , the feasibility of isosulphan blue‐based lymphatic vessel preservation during laparoscopic varicocelectomy  and its impact on the complication rate , as the operative management of varicoceles remains controversial PURPOSE We review the long-term results of varicocele repair , and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital . MATERIAL S AND METHODS We prospect ively studied 100 males 7 to 19 years old with clinical palpable varicocele . Of the patients 52 ( 52 % ) underwent left unilateral varicocelectomy  and 48 ( 48 % ) underwent bilateral varicocelectomy . Varicocelectomy was performed using a microscope in 49 patients ( 79 sites ) , loupe magnification in 25 ( 35 sites ) and no magnification in 26 ( 34 sites ) using either a subinguinal or inguinal approach . Postoperative complications were compared in all patients based on technique . Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients . RESULTS Mean postoperative followup was 30.4 + /- 13.06 months ( 12 to 65 ) . Total motile sperm count increased from 22.6 million + /- 5.16 million to 64.53 million + /- 12.3 million postoperatively , which was statistically significant ( p = 0.002 ) . Postoperative recurrence rates were 0 % in cases managed by microsurgical varicocelectomy , 2.9 % in those where loupe magnification was used and 8.8 % in those where no magnification was used . Postoperative hydrocele rates in these cases were 0 % , 2.9 % and 5.9 % , respectively . The highest rates of recurrence and hydrocele were observed in cases where no magnification was used , compared to those managed by microsurgery ( p = 0.03 and p = 0.116 , respectively ) . CONCLUSIONS Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates . Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification , such as microscopy . Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles Because the treatment of a varicocele in adolescents remains controversial , we undertook a prospect i ve study in 51 male adolescents , aged 15 - 21 years , who were referred for a varicocele . Twenty-nine patients were treated with high retroperitoneal ligation of the left spermatic vein , and 22 were untreated . Eighteen healthy adolescent volunteers without a varicocele were also assessed .  Testicular volume was measured using an orchiometer , and semen analyses were carried out at referral and after 1 year of follow-up . In addition , serum luteinizing hormone ( LH ) , follicle-stimulating hormone ( FSH ) and testosterone levels were estimated by radioimmunoassay . Both patient groups had significantly smaller testis volumes than the controls at the outset . In the follow-up , the treated patients had testis volumes similar to those of the controls . Both testes increased significantly in volume after treatment . Although semen parameters were comparable in all groups initially , sperm concentration increased significantly after treatment of the varicocele . We concluded that varicocele treatment in adolescents leads to increased testis volume and a higher sperm concentration ; however , whether early treatment will improve testicular function remains to be eluci date OBJECTIVE To assess sperm chromatin integrity in infertile men with varicocele before and after surgical repair . DESIGN Prospect i ve . SETTING Academic setting . PATIENT(S ) Seventy-two infertile men with varicocele compared with 20 healthy fertile men . INTERVENTION(S ) History taking , genital examination , semen analysis , sperm chromatin condensation assessment by aniline blue stain before and 3 months after varicocelectomy . MAIN OUTCOME MEASURE(S ) Stained sperm heads ( abnormal chromatin condensation ) before and 3 months after varicocelectomy . RESULT ( S ) The mean percentage of aniline blue-stained sperm heads was significantly higher in infertile men with varicocele compared with fertile controls . The mean percentage of stained sperm heads was significantly decreased in infertile men with varicocele 3 months after surgery compared with the preoperative data . There was a significant negative correlation between percentage of stained sperm heads and normal morphology where nonsignificant correlation was elicited regarding sperm count and sperm motility . CONCLUSION ( S ) There is a significant increase of abnormal sperm chromatin condensation in infertile men with varicocele that is markedly improved after varicocelectomy OBJECTIVE To compare the effect of transumbilical single-site single-port with that of transumbilical single-site double-port laparoscopic varicocelectomy in the treatment of varicocele in adolescents . METHODS We r and omly assigned 80 varicocele patients aged 10 - 16 years to two groups of equal number to receive transumbilical single-site single-port and single-site double-port laparoscopic varicocelectomy , respectively . We compared the operation time , postoperative hospital stay , incisional pain , complications and satisfaction with the abdominal cosmetic outcomes between the two groups . RESULTS All the operations were successfully performed . The double-port group showed a significantly higher score on the Visual Analogue Scale than the single-port group ( 4.8 + /- 1.4 vs 3.6 + /- 1.1 , t = -4.986 , P < 0.01 ) , but there were no significant differences between the two groups in the operation time ( [ 29.8 + /- 4.2 ] vs [ 31.2 + /- 4.6 ] min , t = 1.383 , P = 0.171 ) , postoperative hospital stay ( [ 1.95 + /- 0.7 ] vs [ 1.82 + /- 0.8 ] d , t = -0.784 , P = 0.436 ) , complications ( 0 vs 0 ) and scores on the satisfaction with abdominal cosmetic outcomes ( 4.6 + /- 0.6 vs 4.8 + /- 0.5 , t = 1.253 , P = 0.214 ) . No recurrence , umbilical hernia , hydrocele and orchiatrophy were found in the two groups of patients at 6 months after operation , and no visible scar was observed on the abdominal surface . CONCLUSION With strict surgical indications , single-site single-port and single-site double-port laparoscopic varicocelectomies have similar clinical effects in the treatment of varicocele , which leave no scar on the abdominal surface . Single-site double-port laparoscopy needs no special instruments and therefore is worthier of wide clinical application The aim of this prospect i ve study was to assess long-term functional results ( spermiograms ) in subjects who underwent laparoscopic varicocelectomy via either of 2 procedures ( ligation or preservation of testicular artery ) . A total of 122 patients underwent laparoscopic varicocelectomy performed via either of the 2 different procedures : complete ligation of the spermatic vessels or preservation of the spermatic artery . After surgery when patients achieved 18 years , they were asked to undergo semen analysis . Spermiogram results were divided into 2 subgroups : " normal " and " abnormal . " We analyzed volume , sperm count per mL , percentage of motile spermatozoa , percentage of normal spermatozoa , and percentage of vitality for each group . Both groups showed the same results in terms of " normal " and " abnormal " spermiograms ( World Health Organization criteria ) , but analysis showed higher sperm concentration per mL , sperm motility , volume , vitality , and rate of morphologically normal sperm for the group with arteries preserved and " normal " spermiograms ( P < .01 ) . Analysis of data from the spermiograms showed that preservation of the testicular artery was the best possible option in terms of semen quality . Therefore , we believe that surgical treatment of varicocele should be carried out using procedures involving artery preservation OBJECTIVE To compare the surgical outcomes of subinguinal and high inguinal approaches for microsurgical varicocelectomy . METHODS A total of 81 patients with left varicocele were r and omly assigned to undergo  microsurgical left varicocelectomy by the subinguinal ( n = 41 ) or high inguinal ( n = 40 ) approach . These two techniques were compared with regard to the operative parameters , complications and testicular growth . Anatomical parameters , including the numbers and diameters of internal spermatic arteries , veins and lymphatic vessels , were recorded . RESULTS The microsurgical step was significantly shorter for the high inguinal approach compared with the subinguinal approach ( 25.5 vs 33.3 min , respectively , P < 0.01 ) . The numbers of preserved arteries and ligated veins were significantly greater and the artery size was significantly smaller for the subinguinal ( 1.6 arteries , 11.5 veins and 1.1 mm , respectively ) compared with the high inguinal approach ( 1.2 arteries , 7.3 veins and 1.3 mm ; P < 0.001 , < 0.0001 and < 0.01 , respectively ) . There was one patient with postoperative hydrocele , and three with persistent scrotal pain after treatment with the subinguinal approach . The postoperative catch-up growth rates at 24 months were 70 % and 78 % for the subinguinal and high inguinal approaches , respectively . CONCLUSIONS The microsurgical subinguinal and high inguinal approaches seem to yield similar success rates in terms of testicular growth . However , the high inguinal approach is easier to carry out , as it requires fewer divisions of veins and is associated with a larger diameter of the spermatic artery OBJECTIVE To evaluate mRNA expression of the HSPA2 gene in ejaculated spermatozoa in adolescents with and without varicocele . DESIGN Controlled prospect i ve study . SETTING Patients in an academic research environment . PATIENTS Adolescent patients with clinical diagnosed bilateral varicocele grade s II and III , and adolescent patients without varicocele . INTERVENTION Reverse-transcription-polymerase chain reaction ( RT-PCR ) analysis of HSPA2 gene expression in adolescents with and without varicocele . MAIN OUTCOME MEASURE Comparative RT-PCR expression analysis of HSPA2 gene mRNA , compared to the housekeeping beta-actin gene . RESULTS Sperm from adolescents with varicocele and oligozoospermia had significantly lower levels of HSPA2 gene expression than both adolescents without varicocele ( controls ) and adolescents with varicocele and normal sperm concentration ( P<.05 ) . The latter group had a nonsignificant increase in gene expression compared to the control group . CONCLUSIONS This is the first report on HSPA2 gene expression in ejaculated spermatozoa from adolescents and its relationship with varicocele pathology . Results demonstrated that HSPA2 expression was down-regulated in adolescents with varicocele and oligozoospermia compared to controls . There was a higher , albeit nonsignificant , gene expression in adolescents with varicocele and normal sperm concentration than in controls . We speculate that expression levels of this gene might be used as a molecular marker for the acquisition of thermal tolerance in ejaculated spermatozoa Introduction : The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy . The aim of this study was to prospect ively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes . Patients and Methods : This study included 68 boys with varicoceles , ranging in age from 8 to 19 years . Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography . The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography . A difference of more than 10 % or 2 ml in each testicular volume was considered significant . Results : The mean age of the boys was 13.5 ± 2.3 years . On physical examination , a left unilateral varicocele was diagnosed in 46 boys ( 67.6 % ) . The other 22 boys ( 32.4 % ) had bilateral varicoceles . Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys ( 8.7 % ) who were diagnosed by physical examination as having only left unilateral varicoceles ( grade 3 in 3 patients and grade 2 in 1 patient ) . A different of more than 10 % or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles ( 2.2 % ) . The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test ( r = 0.997 and p < 0.001 for the left testis ; r = 0.998 and p < 0.001 for the right testis ) . Conclusions : Although the management of sub clinical varicoceles remains controversial , these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles , especially in boys with high- grade left varicoceles . In contrast , scrotal ultrasonography , if considered the gold st and ard , did not show superiority over the Prader orchidometer in measuring testicular volumes OBJECTIVES To compare the outcomes of the different surgical techniques used in varicocelectomy . METHODS The study included 120 patients with 147 clinical ly palpable varicoceles who underwent varicocelectomy .  The patients were r and omly allocated to one of three equal groups according to the varicocelectomy technique , which included the open inguinal approach , a laparoscopic approach , and subinguinal microscopic varicocelectomy . The assessment included operative and postoperative parameters , together with semen analysis and pregnancy rate . The mean follow-up was 18 months ( range 11 to 26 ) . RESULTS The operative time in the microscopic group was significantly longer than that for the other two groups . At follow-up , none of the patients of the microscopic group had developed postoperative hydrocele ; however , it was observed in 7 ( 13 % ) of 52 varicoceles in the open group and 10 ( 20 % ) of 50 in the laparoscopic group . This difference was statistically significant in favor of the microscopic group only . Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups , respectively . This difference was statistically significant in favor of the microscopic group only . Improvement in sperm motility and /or concentration was comparable and observed in 65 % , 67 % , and 76 % of the open , laparoscopic , and microscopic groups , respectively . Also , the pregnancy rate at 1 year was not significantly different and was 28 % , 30 % , and 40 % in three groups , respectively . CONCLUSIONS The findings of our study have demonstrated that , compared with open inguinal and laparoscopic varicocelectomy , subinguinal microsurgical varicocelectomy offers the best outcome Purpose Surgical repair of varicocele has long been a procedure to correct spermatogenesis . However , the outcome has been reported to be inadequate . We combined varicocelectomy with supplement therapy to evaluate the concurrent effect of these procedures . Methods A prospect i ve r and omized controlled study was undertaken to investigate the effects of zinc sulfate , folic acid and zinc sulfate/folic acid on sperm quality , protamine content and acrosomal integrity following surgical repair of varicocele . Male subjects with palpable varicocele were included in the study and r and omized into four groups . Subjects received Zinc sulfate , Follic acid , Zinc sulfate/Follic acid or placebo for 6 months . A semen sample was obtained before surgery and 3 and 6 months after surgical repair . Semen sample s were evaluated for sperm parameters as well as chromatin content and acrosomal integrity . Results Most of the evaluated parameters showed a mild improvement after varicocelectomy in the placebo group . Interestingly , co-administration of Zinc sulfate and folic acid improved most factors significantly . Folic acid administration but not zinc sulfate could increase sperm number . Hence , Zinc sulfate was better than folic acid when change in morphology was assessed , and none of them was significantly effective in sperm motility . In Zinc sulfate and Follic acid groups , protamine content and halo formation rate significantly improved . Conclusions We may conclude that co-administration of zinc and folic acid significantly improved sperm parameters and increased varicocelectomy outcomes . So , medical treatment with compatible drugs after surgery might be advantageous for obtaining acceptable results PURPOSE There is evidence that varicocele damage , as reflected by loss of testicular mass , is most striking in the pubertal age group . We attempted to evaluate the long-term effect of early varicocele treatment on testicular growth and sperm count and , thus , determine its prophylactic value . MATERIAL S AND METHODS We compared testicular mass and sperm count in 32 men ( mean age 28 years ) who underwent surgery for varicocele at 11 to 15 years old ( mean age 13 ) to those in 26 untreated , age matched men ( mean age 30 years ) with varicocele and 27 male controls ( mean age 25 years ) . Mean followup in the treated group was 14.5 years ( range 12 to 20 ) . Testicular volumes were measured by ultrasonography . RESULTS There was no significant difference between left and right testicular volumes in the treated or control group , in contrast to the untreated group , in which the left testicles were significantly smaller . Comparison of testicular mass showed a striking similarity between the treated and control groups , while there was a significant difference when the untreated group was compared to the control and operated groups . Total sperm counts were significantly less in the untreated than the treated and control groups . CONCLUSIONS These data support the notion that testicular hypotrophy related to varicocele may be reversed by early intervention and they further strengthen the indication for varicocelectomy in children OBJECTIVES To compare and assess objective ly the postoperative outcome parameters of both microsurgical subinguinal artery sparing and retroperitoneal high ligation techniques for varicocele in infertile men . METHODS We performed a prospect i ve study that included 413 consecutive patients who presented with varicocele . Of the 413 patients , 304 underwent subinguinal varicocelectomy ( group 1 ) and 109 patients underwent high ligation varicocelectomy ( group 2 ) .  Subinguinal varicocelectomies were performed under local anesthesia , with intravenous propofol sedation administered as needed . The operating microscope ( x10 to x16 ) was used to spare the arteries and lymphatics . High ligation was performed through a retroperitoneal approach . RESULTS All patients went home on the evening after surgery with minimal discomfort . No intraoperative complications occurred . The internal spermatic artery was identified in all microvaricocelectomy cases . No testicular atrophy occurred in either group . Five ( 1.6 % ) and seven ( 6.4 % ) hydroceles were identified at the 3-month postoperative visit in groups 1 and 2 , respectively . CONCLUSIONS Microvaricocelectomy is safe and effective and associated with a rapid recovery and minimal morbidity . However , it requires microsurgical training PURPOSE We design ed a r and omized prospect i ve study of male adolescents with moderate and severe varicoceles to determine whether prophylactic varicocele repair is beneficial . MATERIAL S AND METHODS We evaluated 2,100 boys ( 10 to 20 years old ) for genitourinary abnormalities . From this population 2 groups of adolescents 15 to 19 years old with grade 2 or 3 varicoceles were created , including 88 who underwent varicocele repair and 36 controls .  Testicular volume and pampiniform vein diameter were measured , and Doppler ultrasound was performed . RESULTS After 12 months volume of the involved left testis increased to almost normal in treated boys ( mean atrophy index 12.7 % at surgery and 3 % 12 months later ) . In controls the corresponding atrophy indexes were 10 and 9 % , respectively . The relative increase in left testicular volume was 26 % in the surgery group and 11 % in controls . In the surgery group mean pampiniform vein diameter decreased from 2.8 preoperatively to 2 mm . postoperatively but there was no change in controls . CONCLUSIONS Varicocele repair in adolescents with moderate and severe varicocele reversed testicular growth arrest and result ed in catch-up growth within 12 month of surgery OBJECTIVE To examine the hypotheses that clinical varicoceles affect baseline serum total testosterone levels ( T ) and varicocelectomy improves T. MATERIAL S AND METHODS This prospect i ve , nonr and omized , controlled study involved 4 groups of adult men . Varicocele-infertile treatment group ( VIT ) included 66 men who underwent varicocelectomy . Thirty-three varicocele-infertile control men ( VIC ) and 33 varicocele-fertile control men ( VFC ) were only observed . Normal-control ( NC ) group included 33 fertile men without varicocele . Varicocele groups were stratified into baseline hypogonadal ( T < 300 ng/dL ) or eugonadal ( T ≥300 ng/dL ) subgroups . Main outcome measurements were between-group baseline T differences ; and within-group T changes at 6- and 12-month follow-ups of men with varicocele . P < .05 was considered significant . RESULTS Means ( st and ard deviations ) of baseline T in VIT , VIC , VFC , and NC were 347.4 ( 132.1 ) , 339.7 ( 125.8 ) , 396.6 ( 164.9 ) , and 504.8 ( 149.7 ) ng/dL , respectively . The baseline T levels of varicocele groups were comparable , whereas they were significantly low compared with NC group . At 6-month follow-up , VIT demonstrated significant T improvements ( mean change = 44.7 ng/dL ; 12.9 % ; P < .0001 ) . T changes were more remarkable among baseline hypogonadals ( mean change = 93.7 ng/dL ; 40.1 % ; P < .0001 ) compared with eugonadals ( mean change = 8.6 ng/dL ; 2.01 % ; P = .1223 ) . These improvements were persistent at 12-month follow-up . Contrariwise , VIC and VFC exhibited nonsignificant T changes . Postvaricocelectomy T changes correlated significantly and inversely with baseline T ( r = -0.689 ; P < .0001 ) . This correlation was stronger and more significant among hypogonadals ( r = -0.528 ; P = .004 ) than eugonadals ( r = -0.400 ; P = .013 ) . T improvements also exhibited significant positive correlations with preoperative and postoperative sperm concentrations . CONCLUSION Baseline T was significantly low in men with varicocele compared with normal men . Varicocelectomy yielded significant T improvements among hypogonadal men but insignificant changes in eugonadals . T changes correlated strongly and significantly with baseline T and sperm concentrations PURPOSE The left varicocele is usually larger in men with bilateral varicoceles . We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele . To test this hypothesis we prospect ively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large ( grade III ) or moderate ( II ) left varicocele associated with small but palpable ( I ) right varicocele . MATERIAL S AND METHODS A total of 91 patients were prospect ively followed and included in the study . Of the patients 65 underwent bilateral and 26 underwent unilateral left repair . All patients underwent preoperative and postoperative semen analysis . RESULTS Motile sperm concentration increased from 12.1+/-1.7 to 23.7+/-31.8 ( 95.8 % change ) in the bilateral group compared with an increase from 19.5+/-21.4 to 27.8+/-34.8 ( 42.6 % change ) in the unilateral group ( p<0.05 ) . Similarly , sperm concentration increased from 23.8+/-29.5 to 48.6+/-61.3 ( 157.6 % change ) in the bilateral group compared with an increase from 41.1+/-40.9 to 59.5+/-66.7 ( 44.8 % change ) in the unilateral group ( p<0.05 ) . CONCLUSIONS Bilateral varicocelectomy result ed in significantly greater improvement in post-operative seminal parameters than unilateral repair in patients with grade s II to III left varicocele associated with grade I right varicocele . Even a small , unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function . Men with bilateral palpable varicoceles require bilateral repair OBJECTIVE Hydrocele , the main complication of laparoscopic varicocelectomy , is thought to result from a disruption of gonadal lymphatics . The aim of this study was to evaluate the effectiveness of patent blue V dyeing to identify and preserve lymphatic vessels and to assess whether the lymphatic sparing technique avoids postoperative hydrocele in adolescent boys undergoing a laparoscopic procedure . MATERIAL S AND METHODS Fifty-two ( 52 ) boys affected by varicocele Grade III ( range , 12 - 16 years ) underwent a left-sided laparoscopic varicocelectomy . Twenty-six ( 26 ) boys were r and omly assigned to a lymphatic nonsparing ( LNS ) group , and the others to a lymphatic sparing ( LS ) group . Before surgery in the LS group , 2 mL of patent blue V was injected under the tunica dartos on the left side . RESULTS All varicocelectomies were performed laparoscopically . Lymphatic vessels were identified in 23 ( 88.5 % ) boys of the LS group . In the remaining three ( 11.5 % ) , the lymphatics could not be identified clearly . No adverse local or generalized reactions were noted . At a mean follow-up of 14 months , no recurrent varicocele or testicular volume reduction were detected . Hydrocele developed in 4 LNS patients and 1 was operated on . No patient from the LS group developed a hydrocele . CONCLUSIONS Staining gonadal lymph vessels with patent blue V is an effective and simple method of visualization of the lymphatic drainage from the testis . Blue-stained lymph vessels could be readily distinguished and preserved during a laparoscopic varicocelectomy , which results in a decrease of hydrocele development . To vali date an efficacy of vital staining of lymphatic vessels in avoiding hydrocele formation , a larger series and longer follow-up are necessary PURPOSE We prospect ively evaluated changes in sperm chromatin structure in infertile patients before and after surgical repair of varicocele , and the impact on the pregnancy rate . MATERIAL S AND METHODS Included in the study were 49 men with at least a 1-year history of infertility , a palpable varicocele and oligospermia . World Health Organization semen analysis and sperm DNA damage expressed as the DNA fragmentation index using the sperm chromatin structure assay were assessed preoperatively and postoperatively . Pregnancy ( spontaneous and after assisted reproductive technique ) was recorded 2 years after surgery . RESULTS Mean sperm count , sperm concentration and sperm progressive motility improved significantly after varicocelectomy from 18.3 × 10(6 ) to 44.4 × 10(6 ) , 4.8 × 10(6)/ml to 14.3 × 10(6)/ml and 16.7 % to 26.6 % , respectively ( p < 0.001 ) . The DNA fragmentation index decreased significantly after surgery from 35.2 % to 30.2 % ( p = 0.019 ) . When the definition of greater than 50 % improvement in sperm concentration after varicocelectomy was applied , 31 of 49 patients ( 63 % ) responded to varicocelectomy . After varicocelectomy 37 % of the couples conceived spontaneously and 24 % achieved pregnancy with assisted reproductive technique . The mean postoperative DNA fragmentation index was significantly higher in couples who did not conceive spontaneously or with assisted reproductive technique ( p = 0.033 ) . CONCLUSIONS After varicocelectomy sperm parameters significantly improved and sperm DNA fragmentation was significantly decreased . Low DNA fragmentation index values are associated with a higher pregnancy rate ( spontaneous and with assisted reproductive technique ) . We suggest that varicocelectomy should be considered in infertile men with palpable varicocele , abnormal semen analysis and no major female factors INTRODUCTION Adolescent males with varicoceles present a dilemma for surveillance and treatment . Testicular volumetrics have not been shown to predict SA outcomes . Serial SAs are thus recommended in asymptomatic adolescent males with varicoceles and normal testicular development , but the natural history of semen parameters is unknown . OBJECTIVE To explore the natural history of semen parameters in adolescent boys with a left varicocele under active surveillance . STUDY DESIGN Adolescents with an asymptomatic unilateral left varicocele , Tanner V development , normal testicular volumes , and an initial SA were retrospectively review ed in a single-institution prospect ively followed cohort .  Total motile count ( TMC ) was calculated . A cutoff of TMC Z 20 million was used to dichotomize SA results into " normal " or " poor . " Those with poor SA were offered repeat SA . Cumulative probabilities of normal TMC over successive rounds of SA were calculated . Bivariate models were used to explore associations of a second consecutive poor TMC with age and varicocele grade . RESULTS A total of 216 patients provided an initial SA between 1992 and 2015 . We excluded 17 for a history of cryptorchidism or incomplete SA data for a final cohort of 199 patients with median follow-up of 3.3 years ( interquartile range 1.5 - 5.6 years ) . The  mean age at initial SA was 17.9 years ( range 14.8 - 21.8 years ) . One hundred and nine out of 199 had an initial normal TMC . Of the 90 out of 199 with an initially poor TMC , 51 had repeat SA and 24 of the 51 patients improved to normal TMC . Of the 27 patients with two consecutive poor TMCs , 15 had a third SA and five out of 15 improved to normal TMC . Thus , cumulatively , 55 % , 67 % , and 69 % of all patients had a normal TMC after an initial , second , and third SA , respectively . However , fewer patients in each round of SA normalized their TMC ( Figure ) . Neither age nor varicocele grade was associated with a second consecutive poor TMC . DISCUSSION Two-thirds of Tanner V boys with an uncorrected varicocele and normal testicular volumes achieve a normal TMC regardless of varicocele grade or age . Despite Tanner V development , 47 % with an initial " poor " SA will improve to normal status without surgery . However , a small subgroup of patients will have persistently poor TMC and thus should be targeted in future research for timely intervention . CONCLUSION Semen parameters improve over time . SA should be followed and repeated at least once in symptomatic Tanner V boys with varicoceles The purpose of this study is to determine the relative advantages of laparoscopic varicocelectomy compared to the conventional open high ligation of Palomo . We studied 193 patients who presented with varicocele . While 65 patients were treated by open high ligation of the testicular veins  , 128 patients had laparoscopic varicocelectomy .  In addition to varicocele ligation , 14 patients ( 11 % ) had laparoscopy-assisted right orchidopexy , and 5 patients ( 4 % ) had laparoscopic repair of concomitant right inguinal hernia . The mean hospital stay was 3.5 days and 1.3 days , respectively , and the recurrence rates were 10.8 % and 3.9 % , respectively . Return to normal activity was significantly earlier in Group II ( mean 4.5 days ) compared to Group I ( mean 8.9 days ) . There was no incidence of testicular atrophy in any case in the study , regardless of whether the testicular artery was ligated or preserved during surgery . We conclude that laparoscopic varicocelectomy is safe , effective and minimally invasive . In addition to its better cosmetic results and advantage in case of bilateral disease , it allows excellent exposure and control of the affected vessels . Furthermore , the shorter hospital stay and the earlier return to normal activities are very important advantages in recommending this technique as an efficient alternative to the open surgical method PURPOSE We compared the outcomes of 3 techniques of varicocelectomy in infertile patients with varicocele . MATERIAL S AND METHODS The study included 298 infertile patients ( 446 varicoceles ) who were r and omized to varicocelectomy by an open inguinal technique in 92 , laparoscopy in 94 and subinguinal microsurgery in 112 . The 3 techniques were compared regarding intraoperative , and early and late postoperative parameters , changes in semen parameters and the pregnancy rate . Patients were followed a + /- mean + /- SD of 21 + /- 9 months ( range 4 to 35 ) . RESULTS Operative time was significantly longer in the microscopic group . Early postoperative complications were comparable in the 3 groups . At followup none of the patients in the microsurgical group had hydrocele , while it was observed in 4 of 143 ( 2.8 % ) in the open group and in 8 of 148 ( 5.4 % ) in the laparoscopy group , representing a significance difference in favor of microsurgery . The incidence of recurrent varicocele was significantly lower in the microsurgical group than in the open and laparoscopy groups ( 4 of 155 patients or 2.6 % vs 16 of 143 or 11 % and 25 of 148 or 17 % , respectively ) . Compared to preoperative values in the 3 groups postoperative semen parameters showed significant improvement in sperm concentration , motility and morphology . The incidence of patients with improved sperm count and motility was significantly higher in the microsurgical group . The pregnancy rate at 1 year was not significantly different among the 3 groups . CONCLUSIONS Compared with open and laparoscopic varicocele treatment microsurgical varicocelectomy has the advantages of no hydrocele formation , a lower incidence of recurrent varicocele , and better improvement in sperm count and motility OBJECTIVES The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy . We report our results with microsurgical subinguinal varicocele ligation to treat pain . METHODS From 1996 to 1999 , a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele . The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound . Patients described pain with testicular discomfort as scrotal heaviness or a dull ache . While waiting for the operation ( range 3 to 5 weeks ) , all the patients underwent a preoperative trial of conservative management for pain . RESULTS Of 119 men , 82 ( 69 % ) were available for follow-up 3 months postoperatively . Of those 82 patients , 72 ( 88 % ) reported complete resolution of pain , 4 patients ( 5 % ) partial resolution , 5 patients ( 6 % ) no change , and 1 patient ( 1 % ) epididymal discomfort that resolved with conservative measures . Of the 9 patients with partial or no change , 2 patients had reflux recurrence as seen on color Doppler ultrasound . CONCLUSIONS Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients
Based on current available r and omized controlled trials , there is low to moderate level of evidence that radiological or surgical treatment of adolescent varicocele is associated with improved testicular size/growth and sperm concentration .
BACKGROUND The prevalence of varicoceles is as high as 15 % in children and adolescents .
Optimal management of varicoceles has not been consoli date d. Options include observation , radiological intervention , or surgical varicocelectomy .
OBJECTIVE Herein , we aim to assess the outcomes of radiological and surgical interventions for varicocele in children and adolescents evaluated by RCTs .