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Objectives: To assess the role of varicocelectomy in pediatric patients through a careful semen analysis. Methods: A total of 214 patients with grade 2 and 3 left idiopathic varicocele were enrolled. Of these 214 patients, 106 (group 1) were treated surgically for testicular hypotrophy, 54 (group 2) were treated surgically with a normal testis, and 54 with a normal testis (group 3) were observed with follow-up visits every 6 months. The spermiogram results for each group were divided into two subgroups: normal, if they met the evaluation criteria and abnormal in the remaining cases. Results: The spermiogram analysis for groups 1 and 2 showed no statistically significant difference in terms of normal and abnormal spermiogram findings (P >0.01). Even though the patients included in group 3 had reported no testicular hypotrophy or pain, the qualitative semen analysis showed the same trend observed in patients affected by varicocele, but the difference was not statistically significant in the variables considered for the other groups (P >0.01). Preservation of the testicular artery in patients with hypotrophy was associated with better results in terms of semen quality. Conclusions: Testicular hypotrophy remains the most objective indication for surgical treatment of varicocele, and preservation of the testicular artery gives better results in terms of semen quality only in patients affected by testicular hypotrophy. [Copyright &y& Elsevier]

Abstract: Aim of Study: This study evaluates the long-term effect of varicocelectomy as measured by plasma oxidative stress parameters. Methods: Eleven children aged 10 to 16 years presented with left-sided varicocele and ipsilateral testicular hypoplasia. Peripheral blood samples for C-reactive protein, basal thiobarbituric acid reactive substances (TBARS), and plasma peroxidation susceptibility (lag time and slope) were obtained preoperatively and at 1 year after the varicocelectomy. All patients underwent inguinal microvascular varicocelectomy with testicular–inferior epigastric (spermatic-epigastric) venous shunt, and a blood sample from the pampinous plexus was taken. Student''s t test for unpaired and paired data was used with a level of significance set at P < .05. Results: When compared with controls, the cohort preoperative basal TBARS (mean, 2.07 nmol/mL; SD, 0.56 nmol/mL) were higher (P = .009), and plasma peroxidation susceptibility lag time (mean, 132.92 minutes; SD, 32.8 minutes) was lower (P = .0002). Blood samples from the pampiniform plexus showed similar results. Peroxidative plasma levels were significantly reduced on peripheral venous specimens taken 1 year after varicocelectomy with mean (SD) TBARS of 1.53 (0.41) nmol/mL (P = .0003) and mean (SD) lag time of 183.7 (17.46) minutes (P = .0025). The slope did not show significant changes compared with controls, or before and after surgery. Conclusion: Peroxidative plasma levels were significantly reduced 1 year after surgery, indicating that surgical varicocelectomy with construction of venous shunt reduces oxidative stress. [Copyright &y& Elsevier]

Phimosis has been defined as unretractable foreskin without adherences or a circular band of tight prepuce preventing full retraction. We suggested a new treatment protocol combining betamethasone with stretching exercises to reduce the number of patients requiring surgery for phimosis. Between January 2003 and September 2004, 247 boys aged 4 to 14 years (mean 7.6) were included in this consecutive, prospective, open study. Patients were treated with 0.05% betamethasone cream applied to the distal aspect of the prepuce twice daily for the first 15 days, then once daily for 15 more days. Preputial gymnastics started 1 week after topical application of betamethasone. Ninety-six percent of patients receiving 1 or more cycles of betamethasone showed complete resolution of phimosis. There was a significant difference (P < .001) in response rate between the study and control groups. Only 10 boys in the study group had no response to steroid and stretching. Treatment with topical steroids, combined with stretching exercises, is a suitable alternative to surgical correction (preputial plasty/circumcision). [Copyright &y& Elsevier]