UroToday - Kaneko, et al in the December 2007 issue of the International Journal of Urology performed a prospective analysis from Japan regarding the effects of microsurgical repair of varicoceles in both adolescents and adults. The group carried out microsurgical varicocelectomy in 9 boys and 19 men. In the adolescents, successful parameters consisted of catch-up growth of the testis utilizing Lambert volumes. They also evaluated the effect of the grade of the varicocele as well as levels of follicle-stimulating hormone. In the adults, the ratio of sperm concentration improvement, the varicocele grade, testicular volume again done by Lambert volumes as well as serum FSH levels were all evaluated. All the patients were followed for 12 months.

The group found that catch-up growth was seen in 62.5% of the adolescents. They found statistical significance in the FSH levels between boys with catch-up growth and boys without catch-up growth. The FSH levels were higher in the later group. In the adult population, improved sperm concentration was seen in 73.6%. In the adult group the FSH level was significant lower in those with improved sperm concentration than in those without. There were no other correlations seen with the other parameters when compared to the catch-up growth in adolescents or the sperm concentration improvement in adults.

The group concluded that microsurgical varicocelectomy as a treatment for varicoceles with low FSH might be effective. They also showed that catch-up growth was seen in almost two thirds of the adolescent boys after microsurgical repair. They also state further that FSH levels in both adults and adolescents might be a relevant predictive parameter for testicular development. Although microsurgical correction in men is quite clear the dilemma still remains in the adolescents. The adult results in this study which show improvement in 73.6% of adult patients is consistent with what is found in clinical practice where 80-85% of men improved their fertility parameters after microsurgical correction. The catch-up growth that is seen in this paper in the adolescents which is 62.5% is similar to the percentage of boys in adolescents who do have catch-up growth just with yearly ultrasounds and close observation. Testicular asymmetry can occur up to 40% of the time during adolescents up to 18 year of age where we typically see the Lambert volume start to equilibrate. Semen analyses for the patients in this prospective study should be obtained when they are 18 years of age to help solidity the finding of this well done prospective analysis. An interesting arm that could be added to this study are boys who do have discrepancies in Lambert volumes who subsequently develop catch-up growth on their own without microsurgical resection. If the sperm analysis parameters, if compared to those of microsurgical repair, show any difference than one can truly say that microsurgical repair is absolutely necessary in this patient population.

Kaneko T, Sasaki S, Yanai Y, Umemoto Y, Kohri Y

Int J Urol. 14(12): 1080-1083, December 2007

Reported by UroToday Medical Editor Pasquale Casale, MD

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