Nicola Zampieri

Varicocele in Adolescents: A 6-Year Longitudinal and Followup Observational Study

PURPOSE Through a school screening program for varicocele we studied the prognostic value of hemodynamic vs clinical grading for predicting the risk of progression, time to worsening and the final outcome in adolescents with varicocele. MATERIALS AND METHODS A school screening program was set up for boys between ages 10 and 16 years to assess pubertal development, varicocele, testicular vein reflux and testicular volume. Those who eventually had ipsilateral testicular hypotrophy underwent surgery. All patients underwent semen analysis after age 18 years. Varicocele grade was correlated with pubertal development, testicular vein reflux and semen quality in all groups, whether treated or untreated. RESULTS A total of 2,107 boys were screened, of whom 609 had a varicocele. By the end of the study 92 patients (15.1%) had undergone surgery. Hypotrophy correlated with spontaneous testicular vein reflux (high grade) in all cases. Semen analysis showed abnormal results in 36% treated and 20% untreated patients. CONCLUSIONS Children with varicocele should be regularly monitored to identify varicocele grade, testicular volume and vein reflux grade, and management should be determined accordingly. Spontaneous venous reflux toward the testis independent of varicocele grade closely correlates with the onset of testicular hypotrophy and abnormal semen analysis.

A prospective study in children: Pre- and post-surgery use of vitamin E in surgical incisions

BACKGROUND One of the main problems of elective surgery is the cosmetic result. OBJECTIVE This prospective controlled study aims to determine the effects of topical vitamin E on cosmetic results in children. METHODS A single-blind study was carried out. Topical vitamin E was used on the intended incision site for at least 15 days, thrice daily, before surgery and for at least 30 days, twice daily, after surgery (group A). The control group received topical petrolatum-based ointment (group B). RESULTS No patients in group A developed keloids. A total of 96% of patients (or parents) considered the cosmetic results very good. No patients had wound infection. In the control group, only 78% of patients (or parents) considered the cosmetic results very good and 13 (6.5%) patients developed keloids after 6 months. There were no cases of wound infection. CONCLUSION Topical vitamin E before and after surgery improved surgical wound healing and improved cosmetic results.

Foetal and neonatal ovarian cysts: a 5-year experience.

BackgroundAbdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises in this regard even before birth as a result of ultrasound scans carried out during pregnancy. The aim of this study is to highlight the problems posed by the prenatal diagnosis of abdominal cysts in order to outline the most appropriate therapeutic approach in case of suspected ovarian cysts.Materials and methodsBetween January 2003 and January 2007, 57 women were enrolled in this study for a prenatal ultrasound (US) that revealed the presence of an echo-rare or echo-free area in the foetal abdomen. After birth all babies underwent blood tests and abdominal US scans in order to confirm or identify the nature of the cyst. If abdominal US could not show the nature of the cystic formation, magnetic resonance imaging with sedation was performed. When the radiological tests were not useful to identify the nature of the cysts and surgery was then necessary, surgical procedures were performed with laparoscopy.ResultsUltrasounds were useful to identify the diameter of the cysts but not all their origins; also MRI confirmed the morphology and volume of the cysts, but could not give further details about their origin.DiscussionAbdominal ultrasound and finally laparoscopy used to treat and remove the cysts were useful to monitor all simple abdominal cysts. MRI seemed not to be useful for the treatment of this condition, especially in the pediatric age when mild sedation is required.

Varicocele and Retrograde Adrenal Metabolites Flow

Background: Idiopathic varicocele is one of the causes of potentially correctable male subfertility. The mechanisms causing spermatogenesis impairment have yet to be clarified. The aim of this study is to analyze the effects of renal and adrenal metabolite reflux on testicular exocrine function in a rat experimental model. Materials and Methods: In the study, 45 male Lewis Stock adult rats, each weighing 300 g, were used. The rats were subdivided into three groups of 15 rats. In group A (control group) testicular volume and basal follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were measured at the beginning of the study and after 9 months. In group B, varicocele was induced by means of rings introduced in the left renal vein in order to cause a renospermatic reflux. In group C, similarly to group B, varicocele was induced after removal of left adrenal gland. The effects of varicocele on testicular function were then analyzed 3, 6 and 9 months after surgery. After 9 months, all rats underwent testicular biopsy. Results: Both groups B and C showed a reduction in testicular volume, an increase in FSH and a decrease in testosterone levels. These levels were higher in group B. Testicular histological assessment showed important structural abnormalities in group B rats. Conclusions: These data support the hypothesis that renal and adrenal metabolites enhance varicocele-induced testicular damage. This theory is supported both by hormonal impairment and testicular histological analysis.

Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: Ligasure versus transanal hemorrhoidal dearterialization

BACKGROUND Hemorrhoids are the most frequent anal pathology. We evaluated the results of 2 techniques at 1 year after surgery. METHODS The clinical charts and data of patients who underwent hemorrhoidectomy between January 2008 and June 2010 were considered and analyzed. Patients underwent surgery with 2 techniques: transanal hemorrhoidal dearterialization (THD) hemorrhoidectomy or LigaSure-vessel sealing system (Valleylab, Boulder, CO). Patients were chosen randomly to receive one technique or the other. The primary objectives were quality of life, quality of defecation, and regression of symptoms. RESULTS Forty-six patients treated with THD and 68 patients treated with Ligasure were enrolled in the study. No significant differences were observed in the rate of postoperative surgical complications or readmissions. Short- and medium-term (1-6 mo) results showed that THD patients had a higher rate of pain resolution compared with Ligasure patients (P < .05). Functionally, all patients treated with Ligasure showed more postoperative constipation despite administration of laxatives than patients treated with THD. CONCLUSIONS THD is an effective technique and is associated with the best short-term clinical and surgical outcomes if compared with Ligasure.

Testicular Catch-up Growth After Varicocelectomy: Does Surgical Technique Make a Difference?

OBJECTIVES Catch-up growth of the affected testis in adolescents after varicocele repair has been well documented. Many investigators have found evidence that testicular hypotrophy related to varicocele can be reversed by early intervention. The aim of this study was to analyze the testicular catch-up growth rate in pediatric patients, correlating it with patient age at surgery, varicocele size, procedures used, and semen quality. METHODS Between March 1990 and September 2006, a total of 465 varicocelectomies were performed at our department. We evaluated the mean testicular volume before and after varicocelectomy in patients aged 9-14 years. Two procedures were used: laparoscopic artery-preserving varicocelectomy (group 1) and open inguinal microscopic artery-preserving varicocelectomy with a venous-venous bypass (group 2). The testicular volume was measured before and after surgery using ultrasonography, and the mean testicular catch-up growth was recorded. RESULTS Although the overall catch-up growth rate for both groups was 80%, after 18 months, only 45% of patients in group 1 and 34% of patients in group 2 had equal bilateral testicular volume. None of these procedures showed a statistically significant correlation with age at surgery, varicocele size, or catch-up rate. The semen analysis results did not show statistically significant differences between the 2 groups. CONCLUSIONS Although 80% of patients demonstrated testicular catch-up, with a different distribution depending on the procedure type used but without statistically significant differences, only 32% of patients had complete and real testicular volume catch-up.

The laparoscopic Vecchietti technique for vaginal agenesis

Objective: To evaluate surgical, long‐term anatomic and functional results of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis. MethodsRetrospective analysis of 86 women treated at the Department of Gynecology and Obstetrics at the University of Verona, Italy. Data were analyzed based on surgical results and postoperative sexual satisfaction. Depth and diameter of the neo‐vagina was determined. The characteristics of the neo‐vaginal mucosa were investigated by vaginoscopy. Patients reported frequency, satisfaction, and any difficulties found at intercourse. ResultsFunctional success was obtained in 98.1% and anatomic success in 100%. In all patients, at 1 year, the mucosa was pink, trophic, and moist. Two fingers were introduced easily into the neo‐vagina in all cases. All patients, which decided to have sexual intercourse, defined these as satisfying within 6 months. ConclusionsLaparoscopic procedure used in this study is simple, safe, and effective. Anatomical and functional results obtained suggest this laparoscopic procedure as the treatment of choice for this syndrome.

Pseudopapillary tumor in pediatric age: clinical and surgical management

BackgroundSolid pseudopapillary tumors of the pancreas are rare exocrine pancreatic tumors. Through a review of pediatric cases in a single Institution, we present the clinical and surgical management of this neoplasm.MethodsWe retrospectively reviewed the clinical charts of patients treated at our unit between 1995 and 2009 for SPT. Clinical and surgical management were analyzed and reported.ResultsDuring the study period 11 patients underwent surgery for pseudopapillary tumor. Five patients were treated with duodenum-preserving pancreatic head resection and six patients with splenopancreasectomy with a Roux-en-Y pancreatic jejunostomy. Patients did not show recurrence and are currently disease free. Blood tests, Ultrasound, Computed tomography and Magnetic Resonance Imaging were not useful to preoperatively identify the nature of the pancreatic masses.ConclusionSolid pseudopapillary tumor is a rare condition that should be taken into account for the differential diagnosis of pancreatic masses in pediatric age. Due to its favourable prognosis, surgical removal should be planned and done following the intraoperative findings.

Prepubertal serum inhibin B in cryptorchid infants and in monorchid boys with compensatory testicular hypertrophy

OBJECTIVE To investigate the prepubertal serum inhibin B levels in monorchid boys with compensatory testicular hypertrophy (CTH) and in surgically treated cryptorchid boys with normal testicular volume. DESIGN Prospective study. SETTING Pediatric Division, University of Verona, Italy. PATIENT(S) Thirty-two prepubertal boys: 11 monorchids with CTH and 21 cryptorchids. For comparison we analyzed 15 healthy boys. MAIN OUTCOME MEASURE(S) All patients underwent a GnRH agonist test. Inhibin B measurement was performed at basal time. RESULT(S) There was a significant difference in mean testicular volume between monorchid and cryptorchid or healthy children, with boys with CTH evidencing larger testicle volume. There was no significant difference in inhibin B levels between boys with CTH and cryptorchid, but the levels were significantly lower in both groups than in the control group. Boys with CTH had significantly higher serum levels of basal FSH than children with cryptorchid. The FSH peak response to GnRH agonist stimulation was significantly higher in boys with CTH than in those with cryptorchid. CONCLUSION(S) Monorchid infants with CTH showed low inhibin B and high FSH levels. Our finding may confirm the hypothesis that CTH is unable to prevent testicular insufficiency in adulthood. We suggest an early hormonal evaluation of boys with CTH at puberty, together with early sperm analysis.

Painful varicocele in pediatric age: is there a correlation between pain, testicular damage and hormonal values to justify surgery?

PurposePain is one of the indications to treat varicocele at any age. The purpose of this study is to find a possible correlation between pain and objective testicular damage through the analysis of hormonal values.MethodsBetween 1990 and 2001, varicocelectomy was performed on 44 adolescents with painful varicocele using two different techniques. Thirty-eight patients were eligible for the study. Pre- and post-operative hormonal values were analyzed retrospectively to find a possible correlation between pain and testicular damage or discomfort. The patients had to fill out a simple questionnaire about their type of pain following a two-grade rating scale. After treatment, relief of pain or persistence of symptoms were recorded.ResultsSix months after surgery 26 patients showed complete relief of pain. There was not a statistically significant correlation between grade of varicocele, type of surgery and relief of symptoms. Clinically there was not a statistically significant correlation between pain and hormonal values.ConclusionsManagement of painful varicocele in pediatric patients should be studied through randomized trials comparing conservative and surgical treatments. While waiting for objective data supporting surgery, clinical evidence justifies varicocelectomy which, on the other hand, is not supported by objective clinical data (i.e., hormonal values).