ESPU Meeting on Wednesday 17, April 2024, 16:20 - 17:00
16:20 - 16:23
S03-1 (OP)
Daniel BÜRGENER 1, Frank-Mattias SCHÄFER 1, Oliver ROMPEL 2 and Maximilian STEHR 1
1) Cnopfsche Kinderklinik, Department of Pediatric Surgery and Pediatric Urology, Nuremberg, GERMANY - 2) Friedrich-Alexander-Universität (FAU) Erlangen, Radiologische Universitätsklinik, Erlangen, GERMANY
PURPOSE
Testicular Volume (TV) is an clinical decision-making tool in e. g. treatment strategy for adolescent varicocele. While testicular ultrasound has been shown to be superior to Prader orchidometer measurements, recent studies have raised concerns about the validity of testicular ultrasound volume. However, data on larger cohorts of adolescent patients regarding the intra- and interobverver variability of testicular US is scarce.
MATERIAL AND METHODS
Pediatric patients hospitalized for reasons other than testicular pathology were prospectively included for testicular US, performed by a pediatric radiologist (A), a pediatric urologist consultant (B) and a pediatric surgery/urology resident (C). Interobserver variability was calculated within all three investigators. Investigators B and C also performed consecutive ultrasound within 3 days to calculate intraobserver variability. All investigators were blinded to the others as well as their own previous measurements.
RESULTS
22 patients (44 testicular units) were included in the study. A total of 166 measurements were taken. Mean age was 14 yrs (range: 12-17 yrs). 2 patients were excluded from further analysis because of the incidental finding of a testicular pathology. Mean testicular volume was 10.1 ml. Mean overall variability was 10.1 %. Mean Intra-observer variability was 12.6 %, mean inter-observer variability 15.9 %. A TV difference of > 20 % was seen in 29.1 % of the patients in the interobserver group and 23.7 % in the intra-observer group. Subgroup analysis (< / > mean TV) showed the lowest rate of > 20 % TV difference in the intraobserver group with testis > 10 ml (15.0 %).
CONCLUSIONS
Ultrasound measurements of TV has a limited value with a relevant rate of >20 % TV difference measurements both in the intra- and interobserver groups. The highest accuracy was achieved in patients > 10 ml TV in the intraobserver group. This has to be taken into account when clinical decisions are based on TV measurements.
16:23 - 16:26
S03-2 (OP)
Maria SAN BASILIO 1, Sara HERNÁNDEZ-MARTÍN 2, Maria Jose MARTINEZ URRUTIA 3, Susana RIVAS 3, Roberto LOBATO 3, Virginia AMESTY 3, Carla RAMIREZ-AMOROS 1 and Pedro LOPEZ PEREIRA 3
1) Hospital Infantil La Paz, Pediatric Surgery, Madrid, SPAIN - 2) Complejo hospitalario de Navarra, Pediatric Surgery, Pamplona, SPAIN - 3) Hospital Infantil La Paz, Pediatric Urology, Madrid, SPAIN
PURPOSE
Decreased growth of the left testicle (LT) in patients with varicocele has been widely described and a high asymmetry index is used to indicate surgery. This study aims to demonstrate that in patients with a high degree varicocele, the contralateral testicle also has limited growth.
MATERIAL AND METHODS
We conducted a retrospective case-control study. Patients with left varicocele were cases and patients with no pathology affecting testicular growth were controls. Data were collected on age at diagnosis, Tanner stage, symptoms, varicocele degree and ultrasound-measured testicular volume. Testicular volumes were compared between cases and controls, and cases were further subdivided based on varicocele degree.
RESULTS
We included 206 cases (mean age 13±1.4 years) of which most patients had grade 2 (n=106, 51.55%) or grade 3 (n=65,31.6%) varicocele, and 94 controls (mean age 12.7±1.9 years). There was no significant difference in testicular volume between grade 1 varicocele and controls. In those with varicocele grade 2 the volume of the LT was significantly smaller than the controls (p=0.01). In patients with varicocele grade 3 the volume of both testes was significantly smaller than the controls with a volume difference of 38% for the LT (p=0.001) and 28% for the right testicle (RT) (p=0.01). Interestingly, in this group, the LT was only 17% smaller than the RT.
CONCLUSIONS
In patients with grade 3 varicocele, the growth of the contralateral testicle is also affected, therefore, the asymmetry index may no longer be a reliable parameter to indicate surgery in these patients.
16:26 - 16:29
S03-3 (OP)
Marcel DRLÍK
General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Urology, Praha 2, CZECH REPUBLIC
PURPOSE
In adult urology, new methods evaluating sperm quality by flow cytometry using antibodies are gradually introduced. The aim of the study is to assess intraindividual variation of immunological and spermiogram parameters in adolescents with varicocele and to correlate one with another and with clinical findings. This data has not been available so far.
MATERIAL AND METHODS
61 adolescents of median age 17.1 (15.3–17.8) years, with unilateral varicocele grade II (51 %) and III (49 %) in pubertal stage Tanner 5 were prospectively enrolled. Varicocele grade (VG), total testicular volume (TTV), atrophy index (TAI), peak retrograde flow rate and renotesticular reflux were determined by ultrasound. In two semen samples a spermiogram was analyzed according to WHO manual. Vital sperm count (VSC), percentage of apoptotic sperm, sperm with damaged acrosome and DNA fragmentation (SDF) were analyzed by flow cytometry. Non-parametric (Spearman) correlation was used to determine intraindividual variation of semen parametres and their correlation with each other and with clinical findings.
RESULTS
Intra-individual variability of flow cytometry parameters was good (0.45-0.58), better than spermiogram parameters (0.37-0.54). The flow cytometry parameters correlated well with spermiogram in most cases (-0.35-0.88). They correlated poorly with clinical parameters, except of weak correlation of VSC with TTV (0.32) and TAI (-0.30), VG with SDF (0.27).
CONCLUSIONS
Flow cytometry sperm quality parameters in adolescents with varicocele show good stability in repeated examinations, better than spermiogram parameters and they have good correlation with them. However, they correlate poorly with clinical parameters, thus cannot be inferred from clinical findings.
16:40 - 16:43
S03-4 (OP)
Adele RAYMO 1, Luciana LERENDEGUI 2, Daniel TENNENBAUM 3, Rajiv TUMMALA 4, George Andrew RANSFORD 3, Andrew LABBIE 3, Rafael GOSALBEZ 3, Miguel CASTELLAN 3, Daniel E. NASSAU 5 and Alireza ALAM 3
1) University of Miami Miller School of Medicine, Miami, USA - 2) Jackson Memorial Hospital, Pediatric Urology, Miami, USA - 3) Nicklaus Children's Hospital, Pediatric Urology, Miami, USA - 4) Lake Erie College of Osteopathic Medicine, Erie, USA - 5) University of Miami Desai Sethi Urology Institute, Urology, Miami, USA
PURPOSE
Despite the high incidence of varicocele, there remains a substantial lack of consensus on the best approach to diagnosis and treatment. The aim of our study is to assess regional differences in the workup and management of pediatric varicoceles amongst physicians practicing in Europe, North America, and Ibero-America.
MATERIAL AND METHODS
A survey consisting of 21 multiple choice and free response questions was sent to three different pediatric urology societies (ESPU, SPU, and SIUP). Responses were collected anonymously via SurveyMonkey. Z-score and chi-square statistical analyses were used to assess significance.
RESULTS
There were 400 physician responses, from Europe (81), Ibero-America (130), and North America (169) with 20 excluded. We found an increased propensity for European and Ibero-American physicians to consider varicocele grade as an indication for surgery in prepubertal patients (z-score=2.4 and 4.4) and post-pubertal patients (z-score=3.6 and 3.2 respectively), whereas North American physicians were more inclined to select abnormal semen analysis in post-pubertal patients (z score=3.3). For case management of a post-pubertal patient with a G3 varicocele, testicular volume discrepancy >20%, total testicular volume >30cc and normal semen analysis, Ibero-America physicians favored surgical intervention, while North Americans preferred active surveillance (Z-score=3.4 and 3.3). Regarding type of varicocelectomy, Europeans were more inclined to choose laparoscopy and sclerotherapy (z-score=2.3 and 5.4) while Ibero-Americans preferred the inguinal/ sub-inguinal approach (z-score=2.5). European physicians leaned towards the non-artery sparing technique (z-score=2.1) while Ibero-Americans physicians chose artery sparing (z-score=2.4). These associations were statistically significant (p<0.05, Z-score> 1.96).
CONCLUSIONS
Significant regional differences were found in pediatric varicocele management amongst physicians in Europe, Ibero-America and North America.
16:43 - 16:46
S03-5 (OP)
Ana Ludy LOPES MENDES 1, Andrea Celeste BARNESCHI 2, Giulia D'IPPOLITO 3, Del Prete LAURA 3, Michele INNOCENZI 3, Ermelinda MELE 1, Giuseppe COLLURA 3 and Marco CASTAGNETTI 4
1) Bambino Gesù Children Hospital and Research Center, Pediatric Urology, Rome, ITALY - 2) Bombino Gesù Children Hospital and Research Center, Pediatric Urology Unit, Rome, ITALY - 3) Bambino Gesù Children Hospital and Research Center, Pediatric Urology Unit, Rome, ITALY - 4) Bambino Gesù Children Hospital and Research Center, Paediatric Urology Unit, Rome, ITALY
PURPOSE
In order to prevent hydrocele formation after LV, blue lymphography (BL) with vital dyes has been suggested to be a useful adjunct to the preservation of funicular fat for lymphatic sparing (LS). The dye is usually injected in the scrotum, but the adjunct of intra-testicular injection can possibly enhance lymphatic visualization. Intratesticular injection, however, causes concern for the risk of testicular damage.
We reviewed our experience to test the hypothesis that LS-LV with intratesticular injection of the vital dye is safe and increases the chance to avoid post-varicocelectomy hydrocele formation.
MATERIAL AND METHODS
We retrospectively reviewed all consecutive patients undergoing LV <age 18, between 2018 and 2022, and at least 12-month follow-up. We compared the rate of post-operative hydrocele between patients undergoing LS-LV vs. NonLS-LV; between patients undergoing LS with vs. without BL; and finally in those undergoing BL with scrotal vs. intratesticular dye injection.
Hydrocele was defined as a persistent scrotal swelling requiring surgery.
Post-operative testicular ultrasounds at 12-month follow-up were reviewed in patients undergoing BL to rule out anomalies.
Reoperation rate for recurrent varicocele was also analyzed.
RESULTS
130 patients underwent LV at a median(range) age of 14(10-17) years, and 116 had complete follow-up data.
Post-operative hydrocele was significantly more common (p=0.036) in patients undergoing NonLS-LV(3/39, 8%) vs. LS-LV(0/77). No hydrocele was observed in patients undergoing LS-LV with(0/47) vs. without(0/30) BL. Vital dye injections sites were scrotal in 26/47(55%) whereas also intratesticular in 21/47(45%). Non-vascularized intratesticular lesions were identified in 4/21(19%) patients undergoing intratesticular dye injection.
Two varicoceles were reoperated for recurrence, one in each group.
CONCLUSIONS
LS-LV significantly reduced the risk of hydrocele formation. However, this was unrelated to the use of intraoperative BL and intratesticular dye injection was associated with persistent lesions at the 12-month testicular ultrasound in 20% of cases.
16:46 - 16:49
S03-6 (OP)
Ciro ESPOSITO, Rachele BORGOGNI, Annalisa CHIODI, Mariapina CERULO, Giuseppe AUTORINO, Vincenzo COPPOLA, Fulvia DEL CONTE, Claudia DI MENTO and Maria ESCOLINO
Federico II University Hospital, Pediatric Surgery, Naples, ITALY
PURPOSE
Laparoscopic Palomo varicocelectomy using indocyanine green (ICG) fluorescent lymphography (FL) is standardized technique to perform lymphatic sparing and avoid post-operative hydrocele. No data regarding the safety of intratesticular injection of dye are currently available.
The study aimed to assess the safety and efficacy of this procedure at mid-term follow-up.
MATERIAL AND METHODS
Seventy-two patients (median age 14.5 years) undergoing laparoscopic Palomo varicocelectomy using ICG-FL from January 2019 to July 2022, were enrolled. Operative indication was high-grade varicocele in all patients, symptoms in 30/72 (41.7%) and left testicular hypotrophy in 42/72 (58.3%). Follow-up included clinical examination at 1, 6, 12 months and scrotal Doppler ultrasonography (US) at 12 months postoperatively.
RESULTS
Lymphatic sparing using ICG-FL was achieved in all cases. No intra-operative complications or adverse reactions to ICG occurred. The median follow-up was 22.8 months (range 11-49). Self-limited scrotal hematoma at the injection site occurred in 1/72 (1.4%). Intratesticular hypoechoic millimetric area with calcifications was detected in 3/72 (4.2%) on scrotal US. Serum tumor markers were negative. This finding disappeared after 1-year observation in 2/3 cases (66.7%). Persistent grade II varicocele was observed in 4/72 (5.5%), not requiring re-intervention. No hydrocele occurred and 14/22 (63.6%) with pre-operative hypotrophy showed catch-up growth.
CONCLUSIONS
Laparoscopic Palomo varicocelectomy using ICG-FL reported excellent outcomes with low incidence of varicocele persistence and no post-operative hydrocele. These preliminary data confirmed safety of intratesticular injection at mid-term follow-up, without specific risks for testis and patient. Future prospective study with larger series is needed to assess long-term outcomes.