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Varicocele and the horizontal testis: a change in position?
1Department of Paediatric Surgery, Children's Hospital, Dublin, Ireland.
Insights
Horizontal testicular lie in children may indicate an underlying varicocele. This new clinical sign suggests further examination for varicoceles in pediatric patients with this presentation.
Area of Science:
- Pediatric Urology
- Surgical Pediatrics
- Andrology
Background:
- A horizontal lie of the testis has been observed in pediatric patients with varicoceles.
- This association was noted in six children presenting with varicoceles over a six-month period.
- All six pediatric patients exhibited an associated horizontal testicular lie.
Purpose of the Study:
- To investigate the relationship between horizontal testicular lie and varicoceles in children.
- To determine if horizontal testicular lie is a reliable indicator of pediatric varicoceles.
- To evaluate the effect of varicocele treatment on testicular position.
Main Methods:
- Observation of six pediatric patients with varicocele and horizontal testicular lie.
- Surgical intervention (high ligation of internal spermatic veins) in two cases.
- Follow-up examination of seven children who underwent high ligation for varicocele over five years.
Main Results:
- In two cases with high ligation, one patient's testis reverted to a vertical position with varicocele resolution.
- Follow-up of seven children post-high ligation showed varicocele resolution in all.
- All but one of the seven children demonstrated a vertical testicular lie post-treatment.
Conclusions:
- Horizontal testicular lie in children is a novel clinical sign.
- This sign should prompt clinicians to suspect an underlying varicocele in pediatric patients.
- Correction of varicocele may lead to the normalization of testicular position.
Abstract:
Horizontal lie of the testis has recently been observed in association with varicoceles in a pediatric population. Six children with a varicocele presented to the surgical department during a 6-month period. All had an associated horizontal lie of the testis. In two of these cases, high ligation of internal spermatic veins was performed, after which one reverted to a vertical position with resolution of the varicocele. Seven children who underwent high ligation of a varicocoele over a 5-year period were examined. All were found to have no evidence of the varicocele at follow-up. All but one had a vertical lie. Horizontal lie of the testis in children is a new clinical sign that should alert the examiner to the possibility of an underlying varicocele.