Lymphatic sparing microscopic retroperitoneal varicocelectomy: a preliminary experience
PURPOSE/OBJECTIVE:One of the most common approaches to varicocele in adolescents is the Palomo technique. We report the experience of a single surgeon using a modification in which an operating microscope was brought into the field so that lymphatics were identified and preserved. By sparing lymphatics we attempted to reduce the hydrocele rate to levels achieved with microscopic inguinal and subinguinal surgery. MATERIALS AND METHODS/METHODS:A total of 20 boys with grade III varicocele underwent retroperitoneal gonadal vessel ligation with microscope assisted sparing of lymphatics between November 2004 and June 2007. Mean patient age was 15 years and mean followup was 11.2 months (range 1 to 29). RESULTS:Microscopic retroperitoneal varicocelectomy was performed in all patients with sparing of lymphatics under high power microscope. Clinical examination was performed at 1 week, 3, 6 and 12 months, and then annually to assess for recurrence and hydrocele. All boys who were followed had no hydrocele or recurrence. CONCLUSIONS:The microscope has had a large role in inguinal and subinguinal approaches. However, this technique takes up to 2 hours and testicular atrophy has been reported. There were no complications and operative time was shorter. Our technique, which uses magnification in the retroperitoneum, has not been described previously. It combines the simplicity of the original Palomo technique with a short period of microscopic dissection for identification and sparing of the lymphatics. This modification results in high success rates and fewer postoperative hydroceles.
Metabolic and cardiovascular effects of androgen deprivation therapy
Prostate cancer is the most common gender-specific malignancy in men in the USA. Androgen-deprivation therapy (ADT) is commonly used in the treatment of metastatic or recurrent prostate cancer. The use of ADT is increasing with the advocacy of adjuvant and neoadjuvant ADT for treating asymptomatic patients with locally advanced prostate cancer. Although the use of ADT has resulted in improved survival in men with advanced prostate cancer, ADT, with its resulting severe hypogonadism, causes profound metabolic side-effects. We comprehensively reviewed previous reports using Medline searches of English-language literature (1950 to the present), with the keywords 'hypogonadism', 'testosterone', 'androgen deprivation therapy', 'hormonal treatment', 'prostate cancer', 'diabetes', 'metabolic syndrome', and 'cardiovascular disease'. Men with prostate cancer who undergo long-term ADT are at greater risk of developing dyslipidaemia, insulin resistance, hyperglycaemia and metabolic syndrome. These metabolic and physiological changes are a direct result of the induced severe hypogonadism and might predispose patients to a greater risk of cardiovascular morbidity and mortality. There is a need for prospective studies aimed and designed to investigate the metabolic and cardiovascular adverse effects of ADT, and assess the benefit/risk ratio, especially in special populations such as diabetics.