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The first 25 slides, exactly as they appear. The full deck has 76 content slides.
Paediatric Surgery
Varicocele
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
13 sections · 76 slides
Overview
- What this deck will teach you
What a Varicocele Is
- A varicocele in plain language
- Why an asymptomatic vein problem matters
- Varicocele by the numbers
- Epidemiology: a disease that appears at puberty
- Left-sided and (sometimes) both sides
- Bilateral disease is under-recognised in boys
Anatomy and Pathophysiology
- Three arteries feed the testis
- The pampiniform plexus: the vein network that fails
- Why the left side? Three anatomical strikes against it
- Left vs right venous drainage
Making the Diagnosis
- How varicoceles present
- The physical examination – do it properly
- What else could it be? Differential diagnosis
- Dubin–Amelar clinical grading
- A caution about grade
Testicular Volume and Asymmetry
- Why we measure testicular volume
- How to measure it – and the pitfalls
- Testicular asymmetry (“hypotrophy”)
- Total testicular volume and the cut-off problem
- Doppler ultrasound of peak retrograde flow
Doppler: Flow and Vein Size
- Two objective numbers from Doppler
- What PRF may tell us
- What MVD tells us – less certain
- What the guidelines say about ultrasound
Hormonal Function
- The hormone axis, from the ground up
- Baseline hormones usually look normal
- The GnRH stimulation test – stressing the system
- Inhibin B: a marker of Sertoli-cell health
Semen Parameters
- Why semen analysis is hard in boys
- Key studies linking varicocele to worse semen
- Diamond 2007: the asymmetry–semen link
- Semen after varicocelectomy – and DNA fragmentation
Natural History
- Is the varicocele truly progressive?
- Catch-up growth: the reason to sometimes just watch
Indications for Treatment
- Whom to treat – the guideline menu
- Turning guidelines into a practical rule
Treatment Options
- Active surveillance – doing nothing, carefully
- The shared principle of every surgical repair
- Open suprainguinal (Palomo) procedure
- Subinguinal / inguinal microscopic repair
- Spermatic cord and vas at the internal ring
- Laparoscopic varicocelectomy – the US workhorse
- Sealing and dividing a spermatic vein
- Sparing translucent lymphatics during laparoscopy
- Artery-sparing vs artery-ligating – a genuine trade-off
- Laparoscopic vs open, and rarer variants
- Sclerotherapy – blocking veins with a chemical
- Vascular embolization
Follow-Up and Paternity
- Following the boy after repair
- Paternity: the key outcome, barely studied
Summary and Future Directions
- Three things to remember
- Where the field must go next
- Why are varicoceles almost always on the left, and what does that imply clinically?
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- Pediatric Surgery and Pediatric Urology