Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. Repair versus observation in adolescent varicocele: a prospective study. Laparoscopic surgery for pediatric varicoceles: Randomized controlled trial. [Transumbilical single-site single-port versus single-site double-port laparoscopic varicocelectomy for varicocele in adolescents]. 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 Effects of varicocelectomy on testis volume and semen parameters in adolescents: a randomized prospective study. Dye-assisted lymph vessels sparing laparoscopic varicocelectomy. Diagnosis of Pediatric Varicoceles by Physical Examination and Ultrasonography and Measurement of the Testicular Volume Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Varicocele treatment in pubertal boys prevents testicular growth arrest. Effects of varicocele treatment in adolescents: a randomized study. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study. Early post-operative interleukin-6 and tumor necrosis factor-α levels after single-port laparoscopic varicocelectomy in children
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 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 BACKGROUND / PURPOSE The purpose of this investigation was to evaluate the advantages and the shortcomings of laparoscopic varicocelectomy compared with open traditional treatment of varicoceles . METHODS A total of 654 patients were operated on for left-sided varicoceles over 5 years from 1995 to 2000 . To evaluate the clinical efficiency of the treatment , the patients were divided r and omly into 2 groups . Laparoscopic varicocelectomy ( LV ) was performed on 434 patients , and  open varicocelectomy ( OV ) in 220 patients . Outcome data looked at relapse rate , presence of hydrocele , wound complications , and testicular or scrotal edema . Operating time , postoperative length of stay , and pain control also were compared . In both groups , the operations were performed by Palomo 's technique with preservation of lymphatics and mass ligation of the artery and veins in the retroperitoneum above the internal inguinal ring . RESULTS In LV versus OV , relapse rates were 1.84 % versus 1.36 ( P < 0.5 ) , hydrocele occurrence was 0.23 % versus 1.82 % ( P < 0.1 ) , wound complication was 0.23 % versus 7.73 % , and testicular or scrotal edema was 3.9 % versus 13.1 % . LV hospital stay was an average of 3 days versus 7 days for OV . Operating time was 15 minutes for LV versus 26 minutes in open . Postoperative analgesic use was almost cut in half with LV . CONCLUSION The clinical efficacy of LV is superior to traditional OV 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 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 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 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 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 OBJECTIVE To compare semen parameters , pregnancy , recurrence , and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men . DESIGN Prospect i ve , r and omized study . SETTING Ghodran General Hospital , Kingdom of Saudi Arabia . PATIENT(S ) One hundred sixty-two infertile male patients with varicocele . INTERVENTION(S ) Eighty-two patients were treated by microsurgical subinguinal varicocelectomy ( MSSIV ) ( group I ) , whereas 80 patients were treated by conventional , nonmagnified subinguinal varicocelectomy ( NMSIV ) ( group II ) . MAIN OUTCOME MEASURE(S ) The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months . Pregnancy rate was monitored during the follow-up period . RESULT ( S ) Postoperatively , mean sperm count and motility improved significantly in both groups : 42.7 % and 67.1 % of the MSSIV group and 23.7 % and 33.8 % of the NMSIV group showed ≥50 % improvement in sperm count and motility after 1 year . Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV . The pregnancy rate at the end of the follow-up period reached 37.8 % in the MSSIV group and 21.2 % in the NMSIV group . The recurrence rate was zero in the MSSIV group and 11.3 % in the NMSIV group . The rate of hydrocele formation was 1.2 % in the MSSIV group and 8.7 % in the NMSIV group . CONCLUSION ( S ) Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility , higher spontaneous pregnancy rates , and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men 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 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 OBJECTIVE To study the effects of varicocele treatment on  testicular function in adolescents . DESIGN A prospect i ve controlled study in 88 r and omly selected adolescents . SETTING All participants were referred to the fertility outpatient clinic of our university hospital . PARTICIPANTS All participants with a varicocele were r and omly assigned into two groups . Group 1 ( n = 33 ) was not treated , whereas group 2 ( n = 34 ) was treated . A similar group of healthy volunteers without a varicocele served as a control group ( group 3 , n = 21 ) . INTERVENTIONS  Testes volumes were measured at intake and during follow-up using an orchiometer .  Semen analysis was performed according to st and ard procedures both at intake and after 1 year of follow-up . Serum hormone levels were determined at intake using a radioimmunoassay . Treatment was performed by means of transcatheter embolization of the left testicular vein . MAIN OUTCOME MEASURES Testes volumes and semen quality at intake and after 1 year of follow-up were compared within and between the three groups . Hormonal parameters were determined at intake only . RESULTS Before treatment , the mean left testis volume in groups 1 ( n = 26 ) and 2 ( n = 27 ) ( 20.0 mL ; 95 % confidence interval [ CI ] : 18.2 to 21.8 and 21.6 mL ; 95 % CI : 19.4 to 23.8 , respectively ) were significantly smaller than those in the control group ( n = 19 ) ( 24.5 mL ; 95 % CI : 22.7 to 26.4 ) . During follow-up , left testis volumes of the treated group were comparable with those in the control group ( 24.2 mL ; 95 % CI : 22.2 to 26.1 and 24.8 mL ; 95 % CI : 23.0 to 26.7 respectively ) and significantly ( P < 0.001 ) different from the untreated group ( 20.3 mL ; 95 % CI : 18.8 to 21.8 ) . A significant increase in left ( P < 0.01 ) as well as right ( P < 0.05 ) testis volume was observed after treatment . Semen parameters before treatment were not significantly different between the three groups . Sperm concentration increased significantly ( P < 0.01 ) from 47.4 x 10(6)/mL ( 95 % CI : 42.5 to 53.3 ) to 68.9 x 10(6)/mL ( 95 % CI : 50.6 to 87.2 ) in the treated group , whereas semen quality in the untreated and control groups did not change . Although both testes volumes and sperm concentration improved in the treated group , these phenomena were not consistently correlated to each other . CONCLUSIONS Although not apparent in all adolescents , varicocele correction result ed in an increase in left testis volume and sperm concentration . At this moment , it is not clear if early preventive treatment of varicocele in adolescents , in time , will have a positive effect on testicular function 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 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 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 Purpose Laparoendoscopic single-site surgery has recently been described in children and regarded as an improved technology leading to less pain and better cosmetic outcome . Compared to the traditional three-port method , it is not known if the single-port method is less invasive . The aim of this study was thus to investigate the post-operative acute inflammatory response in order to evaluate surgical stress in the two surgical approaches in children . Methods A prospect i ve , single blinded , case-control study was carried out . Thirteen male patients who presented with unilateral varicocele were divided into two groups . Six children underwent  single-port laparoscopic procedure , while the other seven children underwent  three-port laparoscopic procedure . Pre-operative and post-operative blood sample s were taken for the measurement of tumor necrosis factor-α ( TNF-α ) and interleukin 6 ( IL-6 ) using ELISA . Demographics including the operation time , and complications were recorded . Data between the two groups were analyzed using unpaired t-test and a p value of < 0.05 was taken as statistically significant . Results The mean age of patients was 14.5 years ( range 12–19 years ) . There was no significant difference between the two groups in terms of operative time , nor there was any complication recorded . The change in serum TNF-α and IL-6 concentrations pre- and post-operatively between the single-port group and three-port group was not statistically significant . Overall , patients in the two groups showed excellent satisfaction in terms of post-operative cosmesis . ConclusionS ingle-port laparoscopic varicocelectomy is safe , effective and produces excellent cosmesis with minimal surgical stress
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 .