Section of Pediatric Urology, Pediatric Surgery Unit, Department for Mother & Child Care and Urology, University of Palermo, Via Alfonso Giordano 3, 90100 Palermo, Italy. marcello.cimador@ unipa.it
Nat Rev Urol. 2012 Mar 27;9(5):247-57. doi: 10.1038/nrurol.2012.41.
During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack of spontaneous improvement in adolescent patients with ≥ 20% asymmetry between testes. CDUS also enables the detection of varicocele resulting from reflux in the deferential vein adjunctive to a refluxing internal spermatic vein; a causality that accounts for approximately 15% of cases. In addition to a diagnostic role, hemodynamic parameters can be used to predict the risk of persistence or worsening asymmetry. Although further studies are necessary to validate single parameters, it seems that the more severe the reflux, the greater the likelihood that the patient will develop testicular asymmetry.
在青春期，精索静脉曲张的发病风险增加。10 岁以下男孩的患病率低于 1%，但在青春期接近普通成年人群（约 15%）。对于患有精索静脉曲张的青少年男性，手术风险因素尚未明确界定，临床严重程度与预后相关性较差。幸运的是，多普勒超声的广泛应用正在改变这一年龄段的诊断方法。彩色多普勒超声（CDUS）检测到的持续反流被认为具有负预后价值，有证据表明，峰值逆行血流超过 38 厘米/秒是预测青少年患者睾丸之间≥20%不对称性自发改善缺乏的有力指标。CDUS 还可以检测到由伴随反流的精索内静脉反流引起的精索静脉曲张；这种因果关系约占病例的 15%。除了具有诊断作用外，血流动力学参数还可用于预测持续性或加重不对称性的风险。尽管还需要进一步研究来验证单一参数，但似乎反流越严重，患者发生睾丸不对称的可能性就越大。
