Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX.
Baylor College of Medicine, Houston, TX.
Urology. 2014 Aug;84(2):450-5. doi: 10.1016/j.urology.2014.04.022. Epub 2014 Jun 11.
To assess current diagnosis and management of adolescent varicoceles by pediatric urologists.
Online questionnaires assessing diagnosis and management approaches to pediatric and adolescent varicocele were distributed electronically to a national listing of pediatric urologists.
Of 242 pediatric urologists surveyed, 131 (54%) responded to the survey. Only 3% of respondents operate on varicoceles at diagnosis, whereas 14% observe, and 83% base treatment on further indications. Varicocelectomy is most commonly performed for decreased ipsilateral testicular size (96%), testicular pain (79%), and altered semen analysis parameters (39%), with the mean age for varicocelectomy being 12.5 ± 3.1 years. Most physicians use ultrasonography (US) or Doppler US to aid in the diagnosis of varicoceles, and half of physicians would not repair incidental findings of varicocele on US. In an otherwise asymptomatic patient with a varicocele, 28% of physicians would consider varicocelectomy depending on varicocele grade. The most common surgical approaches to varicocelectomy were laparascopic (38%), subinguinal microsurgical (28%), inguinal (14%), and retroperitoneal (13%), and most physicians used loupes for these procedures. The most common complication experienced after adolescent varicocelectomy was hydrocele followed by hematoma, testicular atrophy, chronic pain, paresthesia, and varicocele recurrence or persistence. Only 58% of physicians had follow-up data on their varicocele patients, and 89% did not know whether patients developed infertility. Of patients who developed infertility, 39% had undergone varicocele repair.
Significant variation in diagnostic approaches, decision to treat, and operative approaches exists among pediatric urologists, and combined with a dearth of objective data, limits development of management guidelines.
评估小儿泌尿科医生目前对青少年精索静脉曲张的诊断和治疗方法。
通过电子方式向全国小儿泌尿科医生名单发送在线问卷，评估小儿和青少年精索静脉曲张的诊断和治疗方法。
在接受调查的 242 名小儿泌尿科医生中，有 131 名（54%）对调查做出了回应。只有 3%的受访者在诊断时就进行精索静脉曲张手术，而 14%的人选择观察，83%的人根据进一步的指征进行治疗。精索静脉曲张手术最常因同侧睾丸缩小（96%）、睾丸疼痛（79%）和精液分析参数改变（39%）而进行，手术的平均年龄为 12.5±3.1 岁。大多数医生使用超声（US）或多普勒 US 来协助诊断精索静脉曲张，一半的医生不会在 US 上修复偶然发现的精索静脉曲张。对于无症状的精索静脉曲张患者，28%的医生会根据精索静脉曲张程度考虑行精索静脉曲张手术。精索静脉曲张手术最常见的手术方法是腹腔镜（38%）、腹股沟下显微外科（28%）、腹股沟（14%）和腹膜后（13%），大多数医生使用放大镜进行这些手术。青少年精索静脉曲张手术后最常见的并发症是鞘膜积液，其次是血肿、睾丸萎缩、慢性疼痛、感觉异常和精索静脉曲张复发或持续存在。只有 58%的医生有精索静脉曲张患者的随访数据，89%的医生不知道患者是否患有不育症。在出现不育症的患者中，有 39%的人接受了精索静脉曲张修复。
小儿泌尿科医生在诊断方法、治疗决策和手术方法方面存在显著差异，而且缺乏客观数据，这限制了管理指南的制定。
