Lee Tae Ho, Jung Jay Ho, Hong Young Kwon
Department of Urology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea.
Chonnam Med J. 2016 Sep;52(3):207-11. doi: 10.4068/cmj.2016.52.3.207. Epub 2016 Sep 23.
The aim of this study was to evaluate current practice patterns on diagnosis and management of pediatric varicoceles. Questionnaires of approaches to diagnosis and management of pediatric varicoceles were sent electronically to pediatric urologists. Of the 70 questionnaires e-mailed, 37 (53%) responded to the survey. 10 respondents (27%) chose to operate on varicoceles, whereas 9 (24%) chose to observe, and 18 (49%) chose to decide upon treatment depending on the clinical situation. The most important indication for varicocelectomy was a decrease in ipsilateral testicular size (n=29, 78%) followed by testicular or scrotal pain (n=4, 11%) and varicocele grade (n=4, 11%). The optimal age for varicocelectomy was answered as 13.8±2.3 years mean. 32 respondents (86%) have used ultrasonography to aid in the diagnosis of varicoceles, and 26 respondents (70%) have considered repairing varicocele incidentally detected on ultrasonography. In an otherwise asymptomatic patient with varicocele, 17 respondents (46%) considered surgery for grade 3, but 15 respondents (41%) would not repair the varicocele. The most commonly used surgical approach was subinguinal microsurgical (n=19, 51%), followed by inguinal (n=9, 24%) and laparascopic (n=5, 14%) procedures. The most commonly experienced post-operative complication was recurrence (n=22, 59%) followed by persistence (n=13, 35%) and hydrocele (n=10, 27%). 28 respondents (76%) did not have long-term follow-up data including regarding fertility on their varicocele patients. Our survey demonstrates that there is lack of consensus on diagnosis and management of pediatric and adolescent varicoceles among pediatric urologists. A prospective randomized study of pediatric and adolescent varicoceles is needed to assess the outcomes and develop universal management guidelines.
本研究的目的是评估目前小儿精索静脉曲张诊断和管理的实践模式。小儿精索静脉曲张诊断和管理方法的调查问卷通过电子邮件发送给小儿泌尿科医生。在通过电子邮件发送的70份问卷中，37份（53%）回复了调查。10名受访者（27%）选择对精索静脉曲张进行手术，而9名（24%）选择观察，18名（49%）选择根据临床情况决定治疗方案。精索静脉曲张切除术最重要的指征是患侧睾丸体积减小（n = 29，78%），其次是睾丸或阴囊疼痛（n = 4，11%）和精索静脉曲张分级（n = 4，11%）。精索静脉曲张切除术的最佳年龄回答为平均13.8±2.3岁。32名受访者（86%）使用超声辅助诊断精索静脉曲张，26名受访者（70%）考虑对超声偶然发现的精索静脉曲张进行修复。在精索静脉曲张但无其他症状的患者中，17名受访者（46%）考虑对3级精索静脉曲张进行手术，但15名受访者（41%）不会修复精索静脉曲张。最常用的手术方法是腹股沟下显微手术（n = 19，51%），其次是腹股沟手术（n = 9，24%）和腹腔镜手术（n = 5，14%）。最常见的术后并发症是复发（n = 22，59%），其次是持续存在（n = 13，35%）和鞘膜积液（n = 10，27%）。28名受访者（76%）没有其精索静脉曲张患者的长期随访数据，包括生育能力方面的数据。我们的调查表明，小儿泌尿科医生对小儿和青少年精索静脉曲张的诊断和管理缺乏共识。需要对小儿和青少年精索静脉曲张进行前瞻性随机研究，以评估结果并制定通用的管理指南。
