Adolesan varikoselin değerlendirilmesi

Adolesanlarda varikosel oluşumu testisin büyümeye başlamasıyla birliktedir ve sıklığı erişkin populasyona oldukça benzer niteliktedir. Bu yaş grubunda da tanıda altın standart fizik muayenedir. Testiküler hipotrofı her iki testis arasında 2 mL yada %20'den fazla volüm farkı olarak tanımlanmaktadır ve bu tedaviye karar vermede temel unsur olarak kullanılmaktadır. Tedavide optik büyütme ile uygulanan inguinal veya subinguinal yaklaşım optimal tedavi yaklaşımıdır. Varikoselektomi ile testis volümündeki düzelme yaşa bağlı olmakla beraber postoperatif semen ve hormon parametrelerinde anlamlı düzelmeler sağlanabilmektedir.

Management of adolescent varicocele

Development of varicocele in adolescents is accompanied with testicular growth and its prevelence is similar to adults. Physical examination is the gold standard diagnostic method in this age group, too. Testicular hypotrophy is defined as 20% or 2 ml volume difference between two testicles. This situation is used as a basic condition to decide treatment. Inguinal or subinguinal approach under optical magnification is the optimal treatment method. Although testicular volume regeneration following varicolcelectomy is depending on age, significant improvement can be approached in postoperative semen and hormonal parameters.

Kaynakça

1.Kass EJ. Editorial: adolescent varicocele. J Urol, 154: 1483,1995.

2.Paduch DA: Niedzielski J. Semen analysis in young men with varicocele: preliminary study. J Urol, 156: 788-90, 1996.

3.Akbay E, Çayan S, Doruk E, Duce MN and Bozlu M. The prevalance of varicocele- related testicular atrophy in Turkish children and adolescents. BJU Int, 86: 490, 2000.

4.Çayan S, Akbay E, Bozlu M, et al: The comparison of physical examination, orchidometry, and color Doppler ultrasonography in the diagnosis of pediatric varicocele and the measurement of testicular volume. J Urol, 165(5): S 606, 2001.

5.Salzhauer EW, Sokol A, Glassberg KI. Paternity after adolescent caricocele repair. Pediatrics, 114; 1631-1633,2004.

6.Macleod J: Seminal cytology in the presence of caricocele. Fertil Steril, 16: 735, 1965.

7.Santoro G, Romeo C, I.mpellizzeri P et al: Nitric oxide synthase patterns in normal and varicocele testis in adolescents. BJU Int, 88: 967, 2001.

8.Steno OP: Varicocele in the adolescent. Adv Exp Med Biol, 286:295-321, 1991.

9.Costabile RA, Skoog S, Radowich M. Testicular volume assesment in the adolescent with a varicocele. J Urol, 147: 1348-1350,1992.

10.Skoog SJ, Roberts KP, Goldstein M, et el. The adolescent varicocele:what's new with an old problem in young patients? Pediatrics, 1997; 100: 112- 122.

11.Lenzi A, Gandini L, Bagolan P, Nahum A and Dondero F. Sperm parameters after early left varicocele treatment. Fertil Steril, 69: 347, 1998.

12.Sayfan J, Siplovich L, Kotlun L and Benyamin N. Varicocele treatment in pubertal boys prevents testicular growth arrest. J Urol, 157: 1456, 1997.

13.Dubin L, Amelar RD. Varicocelectomy:986 cases in a twelve-year study. Urology, 1977; 10:446-449.

14.Lenzi A, Gandini L, Bagolan P, Nahum A, Dondero F. Sperm parameters after early left varicocele treatment. Fertil Steril, 69 (2): 347, 1998.

15.Pryor JL, Howards SS. Varicocele. Urol Clin North Am, 14 (3): 499, 1987.

16.Okuyama A, Nakamura M, Namiki M, et al. Surgical repair of varicocele at puberty: preventive treatment for fertility improvement [see comments]. JUrol, 139 (3): 562, 1988.

17.Haans LC, Laven JS, Mali WP, te Velde ER, Wensing CJ. Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varieocele. Fertil Steril, 56 (4): 731, 1991.

18.Pintus C, Rodriguez Matas MJ, Mianzoni C, et al. Varicocele in pediatric patientsxomparative assesment of different therapeuic approaches. Urology, 57: 154-157,2001.

19.Chan P, and Goldstein M. Varicocele:options for management. AUA News 6: 1-5, 2001

20.Paduch DA and Skoog SJ: Current management of adolescent varicocele. Rev Urol, 3: 120-133, 2001.

21.Misseri R, Gershbein AB, Horowitz M, et al: The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy ina long -term follow-up. BJU Int, 87:494-498,2001.

22.Cohen C:Laparoscopic varicocelectomy with preservation of the testicular artery in adolescents. J 36:394-396, 2001.

23.Çayan S, Acar D, Ülger S, Akbay E. Adolesceni varicocele repair: Long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol, 174: 2003-20007,2005.

24.Kass EJ and Marcol B. Results of varicocele surgery in adolescents: a comparison of techniques. J Urol, 148: 694, 1992.

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