Varicocele Management Strategies and Resulting Paternity Rates in a Cohort of Young Adults

Patient Satisfaction and Long-Term Clinical Outcomes in Adolescent Sub-inguinal Microscopic Varicocelectomy

INTRODUCTION AND OBJECTIVE

The long-term outcomes of varicocelectomy in adolescents is debated. The aim of this study was to evaluate symptom improvement, hypogonadism, and paternity in those who underwent adolescent sub-inguinal microscopic varicocelectomy.

MATERIAL AND METHODS

A retrospective chart review was done of adolescents (median=19, interquartile range (IQR)=16-19.75 years) who underwent microscopic varicocelectomy between 2011 and 2021. Demographics, surgical indications, and outcomes were collected, as well as pre- and postoperative hormone levels and semen parameters. A questionnaire was prospectively collected to evaluate orchialgia, paternity, and symptoms of hypogonadism. Descriptive statistics and t-tests were performed, with significance assessed at p-value < 0.05.

RESULTS

A total of 46 adolescents were included. Age at the time of diagnosis and surgery was 19 (IQR=16-20) and 19 (IQR= 18-21) years, respectively. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone were not affected after surgery. Similarly, semen parameters were preserved after varicocelectomy, with median concentration increasing from 12x106/ml to 16x106/ml but not reaching significance (p=0.272). A total of 26 men completed the questionnaire. The age of responders was 22 (IQR=21-24) years, and the time after having had the varicocelectomy was 36.5 (IQR= 18.25-62.25) months. Orchialgia persisted in five men, and three reported having a recurrence. Two men, who had a preoperative abnormal semen analysis, were actively trying to have children and reported successfully having achieved natural pregnancies. None of the patients reported having hypogonadism, and none were receiving testosterone therapy.

CONCLUSION

Our study suggests that microscopic varicocelectomy in adolescents appears to be a safe and feasible procedure with a low rate of syndrome recurrence and no association with symptoms or biochemical evidence of hypogonadism.

Varicocele in adolescence and testicular cancer in young adulthood

BACKGROUND

Elevated intrascrotal temperature has been suggested as a risk factor for testicular cancer, which is the most common neoplasm among young men. Varicocele was linked to increased intrascrotal temperature, but whether it is associated with testicular cancer is unclear.

OBJECTIVE

To explore the possible association between varicocele at adolescence and the incidence of testicular cancer at adulthood.

DESIGN, SETTING AND PARTICIPANTS

This nationwide, population-based, historical cohort study includes 1,521,661 Israeli male adolecents (mean age 17.5 ± 0.4 years), who were screened for varicocele during the years 1967-2012, as part of their medical assessment prior to compulsory military service. The mean follow-up was 18± 4.2 years.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The diagnosis of testicular cancer was ascertained from linkage of records to the the Israeli National Cancer Registry. Survival analysis was applied.

RESULTS

In total, 53,210 adolescents were diagnosed with varicocele stage 2 and 3 prior to military service. Of 1,988 (0.13% of the total cohort) men who were diagnosed with testicular cancer during follow up, 54 (0.1%) had varicocele prior to military service while 1934(99.9%) did not, p = 0.213. The age at cancer diagnosis and the distribution of seminomas vs. non-seminomas did not differ significantly between those with and without varicocele in adolescence. In a multivariable analysis controlling for sociodemographic factors, varicocele was not associated with testicular cancer, odds ratio = 0.816 (CI 0.615-1.083).

CONCLUSIONS

Varicocele in adolecents was not found to be associated with testicular cancer in young adults.

PATIENT SUMMARY

In light of the theoretical association between varicocele and testicular cancer, we conducted this large population study. We found no association between varicocele in young adoulthoot and testicular cancer later in life. This article is protected by copyright. All rights reserved.