Treatment of varicocele in children and adolescents

Ovaj rad je pregled epidemiologije, etiologije, histologije, patofiziologije, kliničke slike i dijagnostike, indikacija za operativni zahvat te prisutpa liječenju varikokele. Pod pojmom varikokele podrazumijevamo varikoznu dilataciju vena pampiniformnog spleta. Kod djece mlađe od 10 godina ovakav nalaz je rijedak, dok se u adolescenata javlja s učestalošću od oko 15%. Nalaz varikokele može biti lijevostran, desnostran i obostran. U kliničkoj praksi najčešće nalazimo varikokele lijeve strane što objašnjavamo retroperitonealnim anatomskim odnosima. Varikokela u adolescenata obično je asimptomatska, no može biti praćena bolovima u skrotumu. Za postavljanje dijagnoze najčešće su dovoljni klinički pregled i ultrazvuk. Budući da ovo stanje može uzrokovati dugoročnu subfertilnost pacijenta, ključno je pravovremeno donijeti odluku o operativnom zahvatu. Postoji više kirurških tehnika za riješavanje ove patologije. Do nedavno, operacije su se vršile isključivo tehnikom otvorenog transingvinalnog ili supraingvinalnog pristupa. Upotreba ostalih, manje invazivnih, metoda sve je češća. Laparoskopske metode su danas metode izbora.This paper is an overview of the epidemiology, etiology, histology, pathophysiology, clinical presentation and diagnostics, as well as of the indications for operating procedures and the approach to varicocele treatment. Under the term varicocele, we assume the varicose dilatation of the pampiniform plexus. In children under the age of 10, this is a rare finding, while it can be found in approximately 15% of adolescents. Varicocele findings can be left-sided, right-sided and both-sided. In clinical practise, we mostly find left-sided varicoceles which can be explained by retroperitoneal anatomy. In adolescents, varicocele is usually asymptomatic, however it can also be accompanied by scrotal pain. For setting a diagnosis, a clinical examination paired with an ultrasound is mostly sufficient. Seeing as how this condition can cause long-term patient subfertility, it is of the utmost importance to make timely decisions on operating procedures. There are a number of surgical techniques that can be used to resolve the pathology. Until recently, operations have been conducted exclusively using the open transingvinal or supraingvinal technique. The use of other, less invasive methods is, however, becoming more often. Nowadays, laparoscopic methods are the methods of choice