Zampieri Nicola, Ottolenghi Alberto, Camoglio Francesco Saverio
Pediatric Surgical Unit, Department of Surgical Sciences, Policlinico G.B.Rossi, University of Verona, Piazzale L.A.Scuro n.1, 37134, Verona, Italy.
Pediatr Surg Int. 2008 Nov;24(11):1235-8. doi: 10.1007/s00383-008-2252-3. Epub 2008 Sep 17.
Pain is one of the indications to treat varicocele at any age. The purpose of this study is to find a possible correlation between pain and objective testicular damage through the analysis of hormonal values.
Between 1990 and 2001, varicocelectomy was performed on 44 adolescents with painful varicocele using two different techniques. Thirty-eight patients were eligible for the study. Pre- and post-operative hormonal values were analyzed retrospectively to find a possible correlation between pain and testicular damage or discomfort. The patients had to fill out a simple questionnaire about their type of pain following a two-grade rating scale. After treatment, relief of pain or persistence of symptoms were recorded.
Six months after surgery 26 patients showed complete relief of pain. There was not a statistically significant correlation between grade of varicocele, type of surgery and relief of symptoms. Clinically there was not a statistically significant correlation between pain and hormonal values.
Management of painful varicocele in pediatric patients should be studied through randomized trials comparing conservative and surgical treatments. While waiting for objective data supporting surgery, clinical evidence justifies varicocelectomy which, on the other hand, is not supported by objective clinical data (i.e., hormonal values).
疼痛是各个年龄段精索静脉曲张治疗的指征之一。本研究的目的是通过分析激素值来找出疼痛与睾丸客观损伤之间可能存在的关联。
1990年至2001年间，采用两种不同技术对44例患有疼痛性精索静脉曲张的青少年实施了精索静脉结扎术。38例患者符合研究条件。对术前和术后的激素值进行回顾性分析以找出疼痛与睾丸损伤或不适之间可能存在的关联。患者必须按照两级评分量表填写一份关于其疼痛类型的简单问卷。治疗后，记录疼痛缓解情况或症状持续情况。
术后6个月，26例患者疼痛完全缓解。精索静脉曲张的程度、手术类型与症状缓解之间不存在统计学上的显著关联。临床上，疼痛与激素值之间不存在统计学上的显著关联。
小儿疼痛性精索静脉曲张的治疗应通过比较保守治疗和手术治疗的随机试验来进行研究。在等待支持手术的客观数据期间，临床证据证明精索静脉结扎术是合理的，然而，客观临床数据（即激素值）并不支持该手术。
