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

Abstract

Background:Postoperative assessment after varicocele surgery in adolescence is commonly centred around catch-up growth of the testis. There is paucity of evidence on the correlation of catch-up growth with underlying testicular function in these patients.Aims:To assess the reliability of catch-up growth of the testis as an indicator of normalization of testicular function and the utility of serum FSH levels in the long-term postoperative assessment of varicocele surgery in adolescence.Materials and Methods:Prospective cohort study of young adults (18-27 years) who had laparoscopic varicocele correction in adolescence (11-16 years). Evaluation included serum FSH levels, scrotal ultrasonography and semen analysis.Analysis:Anatomical and functional parameters of participants with equal and normal testicular size were compared to those of participants with persistent testicular hypotrophy or hypertrophy. Sensitivity and positive predictive value of postoperative serum FSH levels were estimated and elevated levels of serum FSH were checked for association with suboptimal outcomes of varicocele correction.Results:The serum FSH levels of participants with unequal testicular sizes (n=6, median 6.65 IU/l), which included testicular hypertrophy (n=3, median 7.2 IU/l) and persistent testicular hypotrophy (n=3, median 6.1 IU/l), were significantly higher than the group with equal testicular sizes (n=8, median 3.5 IU/l; P=0.014, Mann-Whitney U test). Postoperative elevated serum FSH levels were significantly associated with suboptimal outcomes of varicocele surgery (P=0.015, Fisher's exact test). The test also had a high positive predictive value.Conclusions:Testicular catch-up growth may not be a reliable postoperative assessment criterion by itself. Serum FSH levels may be of value in detecting suboptimal outcomes of varicocele surgery in adolescents.

Surgical management of adolescent varicocele: Systematic review of the world literature

“…It was suggested that hyperplasia of Leydig cells is the poor prognostic factor for fertility. [40] Additionally, the mean testosterone concentration of men with varicocele older than 30 years was found to be significantly lower than that of younger patients with varicocele, whereas this trend was not observed in men without varicocele. Conversely, significant increase in mean testosterone levels was documented after varicocelectomy without concomitant increase in the serum levels of leutinising hormone (LH) and follicle-stimulating hormone (FSH).…”

“…[1138] Or if asymptomatic, it may not present until during investigation of male sub-fertility. [3940] With the recent advancement of imaging technology, most of the varicoceles are diagnosed nowadays incidentally while undergoing scrotal ultrasonography for testicular related pain or other symptoms. [4142]…”

“…Whereas in adult males most varicoceles are identified during investigation for infertility,[3940] in the paediatric and adolescent populations they are commonly diagnosed after referral to a paediatric urologist as a result of an asymptomatic swollen left hemiscrotum. Most of these cases are discovered during a routine examination by a primary care physician.…”

“…[53] These findings suggest a detrimental time-dependent effect of varicocele on Leydig cell function. [4053]…”

“…The LH and FSH serum levels may be determined and used as a marker for post-operative recovery of testicular function. [4053]…”