Effect of microsurgical repair of the varicocele on testicular function in adolescence and adulthood

Abstract

Objective: Many reports on varicoceles suggest improved spermatic findings and increased pregnancy rates after correction of these lesions. Early repair during adolescence has been advocated , since clinically apparent varicoceles may affect testicular volume and sperm production in the future. We examined the efficacy of microsurgical varicocelectomy, and aimed to establish predictive parameters useful for ascertaining whether varicocele repair provides any benefits in adolescents and adults. Methods: We carried out microsurgical varicocelectomy on nine boys and 19 men. In adolescents, catch-up growth of the testis, expressed by pre-and postoperative ratios of left and/or right testicular volume, grade and serum level of follicle-stimulating hormone (FSH) were evaluated. In adults, the ratio of sperm concentration improvement, grade, testicular volume, preoperative sperm concentration and serum FSH level were evaluated. All subjects were followed for 12 months. Results: Catch-up growth was seen in 62.5% of boys. FSH level was significantly lower in boys with catch-up growth than in boys without catch-up growth. Improved sperm concentration was seen in 73.6% of adults. FSH level was significantly lower in adults with improved sperm concentration than in patients without improved sperm concentration. No correlations were seen between other parameters and catch-up growth in adolescents, or sperm concentration improvement in adults. Conclusions: Microsurgical varicocelectomy as a treatment for varicoceles with low FSH might be effective and the relevant predictive parameter for testicular development and function after surgery might be serum FSH level in both adults and adolescents.

The validity of testicular catch-up growth and serum FSH levels in the long-term postoperative assessment of laparoscopic varicocele correction in adolescents

“…Although there have been conflicting reports regarding the utility of preoperative FSH levels to identify those adolescents with varicocele who are at risk of testicular damage, they have been reported to be a reliable test in the postoperative assessment by Kaneko et al . [71213] Our findings also suggest that serum FSH levels seem to successfully predict suboptimal outcomes of surgery (positive predictive value = 100%). Serum FSH level is a test that is easily available and ethically acceptable in all age groups.…”

Laparoendoscopic single‐site urological surgery: Initial experience in Japan

“…But decrease in size of the affected testis is one of the findings that indicate surgical treatment for the patient, 18 as was seen in the present case. As surgical treatment options, several approaches have been reported 19–23 . Laparoscopic varicocelectomy is an accepted procedure and is usually performed using three ports 21–23 .…”

‘Preemptive Hydrocelectomy’ in Subinguinal Varicocelectomy

“…Indeed, the procedure can be avoided in microsurgical subinguinal varicocelectomy as the operating microscope enables a careful lymphatic-sparing surgery [1][2][3][4][5][6][7][8] . It might be recommended, instead, in centers without extensive microsurgical experience.…”

“…Nevertheless, experience with this technique in children remains quite limited with only a few major series reported and often from centers treating both children and adults [3][4][5][6][7][8] . The increased difficulty in accomplishing microsurgical training and keeping microsurgical skills in pediatric centers may account for this observation.…”