PRESENTATION EUROPEAN ASSOCIATION OF PAEDIATRIC UROLOGISTS 2016 Presentation
Published: J Pediatr Urol. 2017 Jan 29. pii: S1477-5131(17)30038-4.
Title: Adolescent sclerotherapy in adolescent varicocele patients
In the 1970s, Tauber described the antegrade sclerotherapy technique to treat varicoceles, and reported a 10% recurrence rate. The present study aimed to evaluate paediatric success rates and the effect of modifications to the surgical technique.
METHODS:
A prospective study was performed of all adolescent patients undergoing antegrade sclerotherapy surgery. Each patient had an idiopathic varicocele with spontaneous venous reflux on Doppler examination, and underwent cannulation of a pampiniform plexus vein via a scrotal incision under general anaesthetic. Aethoxysklerol® 3% (2 ml/kg) maximum 3 ml was injected into the pampiniform plexus vein under fluoroscopic monitoring. Success was assessed by clinical examination and Doppler ultrasound 3, 6 and 9 months after surgery. Data were presented as median (interquartile range). Patients were split into three groups: Group A – liquid sclerotherapy with Y connector; Group B – liquid sclerotherapy direct to cannula; and Group C – foam sclerotherapy direct to cannula. Fisher’s exact test was used to compare the success rates in each group.
RESULTS:
A total of 91 patients underwent antegrade sclerotherapy. The median age was 14.8 years (range 13.7-15.5). Eleven persistent varicoceles occurred and were diagnosed by Doppler ultrasound. The success rate of surgery was 58% in Group A, 90% in Group B and 96% in Group C. Success was significantly higher in Group B and Group C compared with Group A. No testicular atrophy occurred; two wound infections, two haematomas and one hydrocele were recorded (Table).
CONCLUSION:
Introduction of antegrade sclerotherapy in the adolescent population resulted in a safe and cost-effective method for the management of adolescent varicocele. Several modifications to the technique have been introduced to achieve a high success rate (96%) with minimal complications.
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PRESENTATION BRITISH ASSOCIATION OF PAEDIATRIC SURGEONS (UROLOGY SESSION) JULY 2011
Published: J Ped Surg 2012;47:383-385.
Title: TESTICULAR VOLUME AND SEMEN PARAMETERS IN PATIENTS AGED 12-17 YEARS WITH IDIOPATHIC VARICOCELE
Aim: Varicocele is potentially a progressive condition which may affect fertility. The authors have encouraged sperm banking for their post-pubertal patients with varicocele and aim to evaluate the sperm parameters in their cohort of patients.
Methods: The sperm parameters (volume, concentration and forward motility) of post-pubertal varicocele patients who opted for sperm banking were prospectively recorded. The following parameters were also acquired: a) ultrasound measurement of testicular volume, b) clinical grade, c) venous Doppler. Patients were divided into 2 groups: symmetrical testis (group A); asymmetrical testis (group B). Testicular asymmetry was defined as >20% difference in testicular volume compared to contra-lateral testis. Sperm parameters were compared between group A and B using Mann Whitney U test and P <0.05. The study received ethical approval.
Results: Fifteen patients were included, 10 in group A, 5 in group B. Median semen concentration in group B was significantly lower, 3 millions/ml compared to 26 millions/ml in group A. 100% of group B failed WHO adult criteria for normal spermiograms1 compared to 50% of group A.
Conclusions: Sperm concentration was lower in patients with asymmetrical testis. Testicular dysfunction may be present prior to the onset of testicular hypotrophy. When testicular hypotrophy is present testicular dysfunction is very likely.
PRESENTATION BRITISH ASSOCIATION OF PAEDIATRIC SURGEONS (UROLOGY SESSION) JULY 2013
Published: J Pediatr Surg 2014 Feb;49(2):308-11.
Title: Intravenous methylene blue venography during laparoscopic paediatric varicocelectomy
Introduction:
Preventing hydrocele formation and ensuring success is the challenge of varicocele surgery. Methylene blue has been used to identify and preserve lymphatic vessels. Venography is a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined antegrade venography, intravenous methylene blue staining of the internal testicular veins during laparoscopic varicocelectomy and report their experience.
Methods:
A prospective study was performed of adolescent patients with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as PlasmakineticTM or LigasureTM. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6 and 9 months post-surgery with clinical examination and Doppler ultrasound. Data is presented as median (interquartile range).
Results:
24 patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 years (14.6-15.7). The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 minutes (100-126).
Conclusion:
Intra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach to paediatric varicocele prevents hydrocele formation and has a 12% recurrence rate which is higher than some techniques described in the literature.
PRESENTATION BRITISH ASSOCIATION OF PAEDIATRIC SURGEONS (UROLOGY SESSION) 2011
Published:
J Urol 2012;188(2):594-597.
Title:
Sperm banking in the UK is feasible from 13 years of age or older with cancer.
Purpose:
Assisted reproductive technologies are increasingly being used to treat infertility. Male adolescents with cancer are particularly encouraged to bank semen to preserve fertility before beginning chemotherapy or radiotherapy. We evaluated the feasibility of semen preservation in 12 to 17-year-old patients with cancer.
Materials and Methods:
We retrospectively collected data from the sperm banking database at our institution for the years 1995 to 2009. Outcomes measured were histological diagnosis, success rate, sperm concentration and sample volume.
Results:
A total of 180 patients with a mean age of 16.1 years (range 13.2 to 17.9) were referred for cryopreservation during the study period. Underlying diagnoses included lymphoma (64 patients), leukemia (50), bone tumors (18), testicular tumors (13), soft tissue sarcoma (13), brain tumor (6), germ cell tumors (6) and other cancers (10). Of the patients 119 (66%) successfully banked sperm. A total of 26 patients did not attend their appointment. Of those who attended 15 (10%) were unable to provide a sample and 20 (13%) had azoospermia. A total of 20 patients died after banking sperm and their specimens were subsequently destroyed.
Conclusions:
Cryopreservation of semen of acceptable quality for future use in assisted conception is feasible for most adolescents from age 13 years onward.
PRESENTATION BRITISH ASSOCIATION OF PAEDIATRIC SURGEONS (UROLOGY SESSION) 2015
Published:
J Ped Surg 2016 Feb;51(2):293-5.
Title:
Trends in sperm parameters in children and adolescents with idiopathic varicocele and symmetrical testicular volumes
Aim:
Idiopathic varicocele is a common condition that may impair fertility. Its treatment in children and adolescents is reserved for those patients who develop symptoms or testicular growth arrest. In this study, the authors evaluated the trends in sperm parameters in relation to age amongst adolescent varicocele patients with symmetrical testicular volumes who have not undergone varicocelectomy.
Method:
Data was prospectively collected from a single institution from 2009 to 2014. Post-pubertal patients aged 12 to 17 years produced semen samples by masturbation. Outcomes measured were sperm concentration and forward motility. Additional parameters recorded included: a) testicular volume (ultrasound measurement), b) clinical varicocele grade (Dubin & Amelar), c) venous Doppler grading. Linear regression analysis was performed using Fisher’s transformation. P<0.05 was considered significant and data are presented as median (IQ range). The study received ethical approval (REC 09/H1013/15).
Results:
Forty-one patients with a median age of 15 years (15.5-16.4) provided a total of 45 sperm samples during the study period. Thirty-five had grade 3 (visible) varicocele, 6 had grade 2 (palpable) varicocele. All patients had spontaneous venous reflux on Doppler ultrasound and none had undergone varicocelectomy prior to producing the sperm sample. Table 1 summarises the sperm parameters according to patient age. The overall median sperm concentration was 37 millions/ml (16-64) and did not change with age. The overall median forward motility was 55% (44-64) and did not change with age. Both parameters remained within the WHO range of normality.
Conclusions:
Sperm concentration and forward motility were found to be normal and did not vary with age in adolescent varicocele patients with symmetrical testicular volumes. This data seams to support the conservative management for this group of patients.