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Kondoh N, Chikawa A, Okumura M, Hayakawa H, Ohama N, Shigeta M. Significant reduction in left testicular volume shown by ultrasonography in infertile patients with left-side grade 2-3 varicocele as compared to less than grade 2: An evidence for indication of varicocelectomy. Int J Urol 2024; 31:670-677. [PMID: 38402451 DOI: 10.1111/iju.15436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Testicular volume (TV) is known to be one of the main parameters for testicular function (TF). This study was conducted to re-evaluate the indications of a varicocelectomy based on a survey of preoperative TV results in left-side varicocele patients considered to reflect the detrimental effects of a varicocele on TF. METHODS TV results of infertile patients determined using ultrasonography by a single expert physician were retrospectively evaluated. RESULTS Of 590 examined patients, 424 had no varicocele findings (Group A), while 148 had a left-side varicocele (Group B). Group B was subdivided based on varicocele grade into Group B0 (subclinical), B1 (grade 1), B2 (grade 2), and B3 (grade 3). Comparisons of left-side TV showed no significant differences for grade among Group A, B0, and B1, whereas that for Group B2 and B3 was significantly lower as compared with Group A (p < 0.01, 0.02, respectively). The median TV of Group B I (composed of Groups B0 and B1) was 9.8 cm3, while that of Group B II (Groups B2 and B3) was significantly lower at 8.4 cm3 (p < 0.05). In contrast, a comparison of right TV values identified no significant differences among the groups (p = 0.918). CONCLUSION A varicocelectomy should be performed for patients with a grade 2 and 3 varicocele for ameliorating testicular function.
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Affiliation(s)
- Nobuyuki Kondoh
- Advanced Fertility Center of Fuchu Nozomi, Osaka, Japan
- Kawanishi City Medical Center, Kawanishi, Hyogo, Japan
| | - Ai Chikawa
- Advanced Fertility Center of Fuchu Nozomi, Osaka, Japan
| | | | | | - Naoko Ohama
- Advanced Fertility Center of Fuchu Nozomi, Osaka, Japan
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The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study. J Pediatr Urol 2017; 13:77.e1-77.e5. [PMID: 27815047 PMCID: PMC5453725 DOI: 10.1016/j.jpurol.2016.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/21/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Adolescent males with varicoceles present a dilemma for surveillance and treatment. Testicular volumetrics have not been shown to predict SA outcomes. Serial SAs are thus recommended in asymptomatic adolescent males with varicoceles and normal testicular development, but the natural history of semen parameters is unknown. OBJECTIVE To explore the natural history of semen parameters in adolescent boys with a left varicocele under active surveillance. STUDY DESIGN Adolescents with an asymptomatic unilateral left varicocele, Tanner V development, normal testicular volumes, and an initial SA were retrospectively reviewed in a single-institution prospectively followed cohort. Total motile count (TMC) was calculated. A cutoff of TMC Z 20 million was used to dichotomize SA results into "normal" or "poor." Those with poor SA were offered repeat SA. Cumulative probabilities of normal TMC over successive rounds of SA were calculated. Bivariate models were used to explore associations of a second consecutive poor TMC with age and varicocele grade. RESULTS A total of 216 patients provided an initial SA between 1992 and 2015. We excluded 17 for a history of cryptorchidism or incomplete SA data for a final cohort of 199 patients with median follow-up of 3.3 years (interquartile range 1.5-5.6 years). The mean age at initial SA was 17.9 years (range 14.8-21.8 years). One hundred and nine out of 199 had an initial normal TMC. Of the 90 out of 199 with an initially poor TMC, 51 had repeat SA and 24 of the 51 patients improved to normal TMC. Of the 27 patients with two consecutive poor TMCs, 15 had a third SA and five out of 15 improved to normal TMC. Thus, cumulatively, 55%, 67%, and 69% of all patients had a normal TMC after an initial, second, and third SA, respectively. However, fewer patients in each round of SA normalized their TMC (Figure). Neither age nor varicocele grade was associated with a second consecutive poor TMC. DISCUSSION Two-thirds of Tanner V boys with an uncorrected varicocele and normal testicular volumes achieve a normal TMC regardless of varicocele grade or age. Despite Tanner V development, 47% with an initial "poor" SA will improve to normal status without surgery. However, a small subgroup of patients will have persistently poor TMC and thus should be targeted in future research for timely intervention. CONCLUSION Semen parameters improve over time. SA should be followed and repeated at least once in symptomatic Tanner V boys with varicoceles.
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Verim S, Uguz S, Celikkanat S, Guragac A, Turker T, Topuz B, Demirci R, Alp BF, Irkilata HC, Sağlam M. Prognostic Predictors of Fertility in Young Adult Patients With Varicocele: Peak Retrograde Flow Velocity and Reflux Grade. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1241-1250. [PMID: 27151907 DOI: 10.7863/ultra.15.07072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to determine prognostic factors affecting semen parameters in patients with varicocele during the postadolescent period. METHODS This study was approved by the Institutional Review Board. Between May 2013 and May 2015, we prospectively obtained demographic and sonographic data from postadolescent patients with varicocele. Potential risk factors affecting semen parameters, including age at diagnosis, height, weight, body mass index, varicocele laterality, varicocele grade, left testicular volume, right testicular volume, total testicular volume, testicular atrophy index, testicular volume differential, right and left maximum vein diameters, peak retrograde flow velocity, reflux flow volume, and reflux grade in both supine and standing positions, were recorded. RESULTS The left peak retrograde flow velocity, reflux flow volume, and reflux grade in the supine and standing positions, left testicular volume, right testicular volume, total testicular volume, and follicle-stimulating hormone level were found to be associated with abnormal semen parameters (P < .05). By multivariate analysis, the follicle-stimulating hormone level was associated with the sperm concentration and morphologic characteristics, and the left peak retrograde flow velocity in the standing position was associated with deterioration of sperm motility and morphologic characteristics. Additionally, the left reflux grade in the standing position was associated with the sperm concentration, and the left testis volume was associated with motility. CONCLUSIONS The left peak retrograde flow velocity and reflux grade in the standing position were significantly associated with all semen analysis parameters. This finding supports the use of testicular duplex Doppler sonography as a noninvasive tool for evaluation of testicular function in patients with varicocele and helps clinicians determine patients' fertility status.
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Affiliation(s)
- Samet Verim
- Department of Radiology, Mevki Military Hospital, Ankara, Turkey
| | - Sami Uguz
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Serhat Celikkanat
- Department of Radiology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Ali Guragac
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Turker Turker
- Department of Public Health, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Bahadir Topuz
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Ramazan Demirci
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Bilal Firat Alp
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Hasan Cem Irkilata
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Mutlu Sağlam
- Department of Radiology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
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Semen Parameters in Adolescents with Varicocele: Association with Testis Volume Differential and Total Testis Volume. J Urol 2015; 193:1843-7. [DOI: 10.1016/j.juro.2014.10.111] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/20/2022]
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Garolla A, Torino M, Miola P, Caretta N, Pizzol D, Menegazzo M, Bertoldo A, Foresta C. Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod 2015; 30:1006-13. [DOI: 10.1093/humrep/dev057] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/20/2015] [Indexed: 11/14/2022] Open
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Liu J, Ding D, Liu J. Varicocele-caused progressive damage in bilateral testis and sertoli cell-only syndrome in homolateral testis in rats. Med Sci Monit 2014; 20:1931-6. [PMID: 25313556 PMCID: PMC4207290 DOI: 10.12659/msm.891324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background We aimed to investigate whether varicocele (VC) in rats can cause Sertoli cell-only syndrome (SCOS). Material/Methods Forty adolescent SD rats were randomly divided into 4 groups: 4-weeks control group, 4-weeks experimental group, 12-weeks control group, and 12-weeks experimental group. Left varicocele models were introduced by partially ligating left kidney veins for the experimental groups, and the sham surgery groups as controls were executed with exactly the same surgery as in the experimental groups except for the ligation. Rats in control and experimental groups for 4 and 12 weeks were killed after laparotomy at 4 and 12 weeks, respectively, the testes were taken out and fixed in fixative containing 4% polyformaldehyde, then were stained by hematoxylin and eosin (HE). The density and viability of sperm were analyzed by computer-aided sperm analysis. Results Compared with rats in 4-weeks and 12-weeks control group, histological structures of bilateral testes in both experimental groups were impaired, most of them showing as focal focuses. The pathological changes of testes in rats of the 12-weeks experimental group were bilateral, and included atrophy of seminiferous tubules, turbulence of spermatogenic cells in seminiferous tubules, defluvium of most spermatogenic cells, abortion of spermatogenesis, and degradation of spermatogenic epithelia. One rat in the 12-weeks experimental group was shown having SCOS, with the spermatogenic cells in seminiferous tubules completely flaked, degraded, or absent, and only Sertoli cells lined the seminiferous tubules. Conclusions Laboratory VC caused progressive impairment of homolateral testes, and SCOS could be induced when the damage was severe. Our results indicate that asthenozoospermia, azoospermia, and SCOS can be prevented by the earlier treatment of VC.
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Affiliation(s)
- Jianjun Liu
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China (mainland)
| | - Degang Ding
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China (mainland)
| | - Jie Liu
- Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China (mainland)
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Active surveillance of the adolescent with varicocele: predicting semen outcomes from ultrasound. J Urol 2013; 191:1401-6. [PMID: 24231835 DOI: 10.1016/j.juro.2013.11.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE We hypothesized that active surveillance of the adolescent varicocele is not associated with a high prevalence of suboptimal semen analysis and that patients with abnormal semen analysis have smaller testicular volumes and larger volume differentials. MATERIALS AND METHODS We conducted an institutional review board approved retrospective cohort study of adolescents with a clinically detected varicocele. Patients were initially observed by serial scrotal ultrasound evaluating testicular size and differential. Semen analysis was routinely collected in Tanner V cases, around age 18 years. Prevalence of normal semen analysis parameters was calculated, and logistic regression was used to model the ability of age at presentation and testicular volume parameters to predict a normal semen analysis. RESULTS A cohort of 73 patients underwent surveillance with a mean ± SD age at presentation of 15.5 ± 2.3 years. Median followup was 2.7 years, during which time subjects underwent a median of 3 scrotal ultrasounds. A low total motile count was found in 48 patients (66%). Neither age at presentation nor testicular volume differential could predict normal semen volume, density, sperm motility or total motile count. Total testicular volume from the final ultrasound predicted total motile count (p = 0.008). However, the collective observations of volume during the entire period of surveillance could not predict total motile count (p = 0.847). CONCLUSIONS There is a high prevalence of suboptimal semen analysis in adolescents with a varicocele who are followed with active surveillance. Total testicular volume can predict total motile count at the end of adolescence but not throughout.
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Akdemir S, Gurocak S, Konac E, Ure I, Onen HI, Gonul II, Sozen S, Menevse A. Different surgical techniques and L-carnitine supplementation in an experimental varicocele model. Andrologia 2013; 46:910-6. [DOI: 10.1111/and.12172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- S. Akdemir
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
| | - S. Gurocak
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
| | - E. Konac
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
| | - I. Ure
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
| | - H. I. Onen
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
| | - I. I. Gonul
- Faculty of Medicine; Department of Pathology; Gazi University; Ankara Turkey
| | - S. Sozen
- Faculty of Medicine; Department of Urology; Gazi University; Ankara Turkey
| | - A. Menevse
- Faculty of Medicine; Department of Medical Biology and Genetics; Gazi University; Ankara Turkey
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Azizollahi G, Azizollahi S, Babaei H, Kianinejad M, Baneshi MR, Nematollahi-mahani SN. Effects of supplement therapy on sperm parameters, protamine content and acrosomal integrity of varicocelectomized subjects. J Assist Reprod Genet 2013; 30:593-9. [PMID: 23435530 PMCID: PMC3644122 DOI: 10.1007/s10815-013-9961-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/14/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Surgical repair of varicocele has long been a procedure to correct spermatogenesis. However, the outcome has been reported to be inadequate. We combined varicocelectomy with supplement therapy to evaluate the concurrent effect of these procedures. METHODS A prospective randomized controlled study was undertaken to investigate the effects of zinc sulfate, folic acid and zinc sulfate/folic acid on sperm quality, protamine content and acrosomal integrity following surgical repair of varicocele. Male subjects with palpable varicocele were included in the study and randomized into four groups. Subjects received Zinc sulfate, Folic acid, Zinc sulfate/Folic acid or placebo for 6 months. A semen sample was obtained before surgery and 3 and 6 months after surgical repair. Semen samples were evaluated for sperm parameters as well as chromatin content and acrosomal integrity. RESULTS Most of the evaluated parameters showed a mild improvement after varicocelectomy in the placebo group. Interestingly, co-administration of Zinc sulfate and folic acid improved most factors significantly. Folic acid administration but not zinc sulfate could increase sperm number. Hence, Zinc sulfate was better than folic acid when change in morphology was assessed, and none of them was significantly effective in sperm motility. In Zinc sulfate and Folic acid groups, protamine content and halo formation rate significantly improved. CONCLUSIONS We may conclude that co-administration of zinc and folic acid significantly improved sperm parameters and increased varicocelectomy outcomes. So, medical treatment with compatible drugs after surgery might be advantageous for obtaining acceptable results.
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Affiliation(s)
- Gholamabbas Azizollahi
- />Department of Urology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- />Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Azizollahi
- />Department of Anatomy, Division of Reproductive Biology, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoon Babaei
- />Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mohammadali Kianinejad
- />Food and Drug Laboratory, Vice Chancellor of Food and Drug, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- />Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Noureddin Nematollahi-mahani
- />Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
- />Department of Anatomy, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- />Afzal Resaerch Institute (NGO), Kerman, Iran
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Abstract
Evaluation and surgical treatment of male infertility has evolved and expanded, now leading to more precise diagnoses and tailored treatments with diminished morbidity and greater success. Surgeries for male infertility are divided into four major categories: (i) diagnostic surgery; (ii) surgery to improve sperm production; (iii) surgery to improve sperm delivery; and (iv) surgery to retrieve sperm for use with in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI). While today we are more successful than ever in treating male infertility, pregnancy is still not always achieved likely due to factors that remain poorly understood. Clinicians treating infertility should advocate for couple-based therapy, and require that both partners have a thorough evaluation and an informed discussion before undergoing specific surgical therapies.
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Zampieri N, Pellegrino M, Ottolenghi A, Camoglio FS. Effects of bioflavonoids in the management of subclinical varicocele. Pediatr Surg Int 2010; 26:505-8. [PMID: 20162420 DOI: 10.1007/s00383-010-2574-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subclinical varicocele is a relative rare condition. The aim of this study is to identify the role of bioflavonoids in the management of subclinical varicocele. MATERIALS AND METHODS We analyzed the medical charts of patients treated for subclinical varicocele with bioflavonoids between 1999 and 2004; inclusion criteria were created before treatment. Short and long-term results after treatment were studied and compared with untreated patients. RESULTS One hundred and sixty-eight patients with left subclinical varicocele were included in the study. Long-term results showed a possible correlation between use of bioflavonoids and lesser rate of clinical progression to palpable varicocele (11 vs. 31%), higher rate of stable vein reflux (47 vs. 38%) and higher resolution rate (41 vs. 31%) (p > 0.05). Bioflavonoids did not show any protective factor against testicular growth arrest. CONCLUSIONS Subclinical varicocele should be considered as the starting point of varicocele, and although the use of bioflavonoids in patients with subclinical varicocele could reduce the development of palpable varicocele, it cannot prevent the onset of testicular growth arrest.
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Affiliation(s)
- Nicola Zampieri
- Pediatric Surgical Unit, Department of Anesthetic and Surgical Sciences, University of Verona, Policlinico G.B.Rossi, piazzale L.A.Scuro n.1, 37134, Verona, Italy.
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Caretta N, Palego P, Schipilliti M, Torino M, Pati M, Ferlin A, Foresta C. Testicular contrast harmonic imaging to evaluate intratesticular perfusion alterations in patients with varicocele. J Urol 2010; 183:263-9. [PMID: 19942233 DOI: 10.1016/j.juro.2009.08.140] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether changes in intratesticular microcirculation perfusion affect spermatogenesis in patients with left varicocele we performed testicular contrast harmonic imaging. MATERIALS AND METHODS A total of 90 patients with left varicocele (oligospermia in 50 and normozoospermia in 40) and 36 controls without varicocele (oligospermia in 16 and normozoospermia in 20) were enrolled in the study. Before contrast harmonic imaging all participants were evaluated by clinical examination, hormonal analysis, semen sample and scrotal ultrasound. We calculated contrast material arrival time in the arteriolar circulation (wash-in), time to peak in arterial circulation, arrival time in the venular circulation (washout) and mean transit time in each testis on contrast harmonic imaging. RESULTS We found no difference in the distribution rate of varicocele grade in patients with vs without oligospermia. All contrast harmonic imaging parameters were significantly higher in patients with varicocele plus normozoospermia or oligospermia and controls. We found no significant differences in contrast harmonic imaging parameters in patients with lower varicocele grading with respect to the higher grades. In patients with varicocele we found a negative linear correlation between total sperm count and left mean transit time (r = -0.29). In a multivariate model left mean transit time was the only independent predicting parameter of oligospermia (p <0.05). Mean transit time greater than 36 seconds predicted oligospermia in patients with left varicocele with 78% sensitivity and 58% specificity. CONCLUSIONS To our knowledge we report for the first time that testicular contrast harmonic imaging may be a new diagnostic tool able to improve our knowledge about the influence of varicocele on intratesticular microcirculation.
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Affiliation(s)
- Nicola Caretta
- Section of Clinical Pathology, Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Centre for Male Gamete Cryopreservation, Padova, Italy
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Abstract
Whether or not varicocele causes infertility is a contentiously debated issue. This study aimed to compare semen parameters and pregnancy rate in infertile males who underwent varicocelectomy with preserved or accidentally ligated testicular artery. Ninety-five infertile oligoasthenozoospermic patients with left-sided varicocele were subjected to subinguinal varicocelectomy with trial of preserving testicular artery. According to absence or presence of testicular artery in the histological excised pedicle the cases were divided into two groups; group 1 (n = 60) with preserved testicular artery and group 2 (n = 35) where the artery was accidentally ligated being not defined or injured. Semen analysis was carried out after 4, 8 and 12 months and post-operative pregnancy rate was assessed after 1 year. Serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone (T) were estimated pre- and post-operatively. Semen parameters (total sperm count, sperm concentration and sperm motility) showed significant increase post-operatively compared with pre-operative parameters but were comparable in both groups with no significant difference. Serum FSH, LH, T hormones and pregnancy rate (23.3% versus 22.9%) 1 year post-operatively showed no significant difference. It is concluded that accidental ligation of testicular artery has no deleterious effect on semen parameters during primary varicocele repair if the testicular arterial supply was not compromised.
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Affiliation(s)
- H K Salem
- Urology Departments, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Zampieri N, Mantovani A, Ottolenghi A, Camoglio FS. Testicular catch-up growth after varicocelectomy: does surgical technique make a difference? Urology 2008; 73:289-92. [PMID: 18817958 DOI: 10.1016/j.urology.2008.07.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 07/08/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico GB, Verona, Italy
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