Mori Marcos Mitsuyoshi, Bertolla Ricardo Pimenta, Fraietta Renato, Ortiz Valdemar, Cedenho Agnaldo Pereira
Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil.
Fertil Steril. 2008 Nov;90(5):1769-73. doi: 10.1016/j.fertnstert.2007.09.052. Epub 2007 Dec 31.
To determine whether grade of varicocele determines extent of alterations to semen quality in adolescents.
Prospective study.
Patients recruited from a local public school.
PATIENT(S): Adolescents (14 to 18 y of age) attending a local public school.
INTERVENTION(S): Scrotal palpation in a temperature-controlled room, testicular volume assessment with a Prader orchidometer, and semen analysis according to World Health Organization guidelines, with morphology by Kruger's strict criteria.
MAIN OUTCOME MEASURE(S): Presence, and grade, or absence of varicocele; testicular volume (assessed with a Prader orchidometer); semen analysis results; and prevalence of testicular asymmetry.
RESULT(S): Among the adolescents, 27.8% (95% confidence interval [CI]: 23.2, 32.4) presented varicocele grades II and III, and 7.8% (95% CI: 5.0, 10.6) presented with a grade III varicocele. There was a high prevalence of testicular asymmetry in adolescents with left grade II (41.7%) and III varicocele (51.9%), whereas adolescents without varicocele showed very low testicular asymmetry (11.0%). Testicular asymetry was significantly less prevalent in adolescents without varicocele. Sperm progressive motility and concentration were lower in the two varicocele groups but were not different according to grade. However, the total number of progressively motile sperm in the ejaculate was lower in the varicocele grade II and III groups, and patients with varicocele grade III presented lower values than those with grade II.
CONCLUSION(S): Grades II and III varicocele cause a decrease in testicular volume and in semen quality that is independent of grade, but when assessing the total number of progressively motile sperm in the ejaculate, grade III varicoceles place these adolescents very close to the World Health Organization cutoff rate, and thus, current guidelines for treating the adolescent varicocele may need to be revised.
确定精索静脉曲张的分级是否决定青少年精液质量改变的程度。
前瞻性研究。
从当地一所公立学校招募患者。
就读于当地一所公立学校的青少年（14至18岁）。
在温度受控的房间内进行阴囊触诊，使用普拉德睾丸测量器评估睾丸体积，并根据世界卫生组织指南进行精液分析，采用克鲁格严格标准评估形态学。
精索静脉曲张的存在与否及分级；睾丸体积（用普拉德睾丸测量器评估）；精液分析结果；以及睾丸不对称的发生率。
在青少年中，27.8%（95%置信区间[CI]：23.2，32.4）存在II级和III级精索静脉曲张，7.8%（95%CI：5.0，10.6）存在III级精索静脉曲张。左侧II级（41.7%）和III级精索静脉曲张（51.9%）的青少年中睾丸不对称的发生率很高，而无精索静脉曲张的青少年睾丸不对称发生率非常低（11.0%）。无精索静脉曲张的青少年中睾丸不对称的发生率明显较低。两个精索静脉曲张组的精子前向运动率和浓度较低，但根据分级并无差异。然而，II级和III级精索静脉曲张组射精液中前向运动精子的总数较低，III级精索静脉曲张患者的值低于II级患者。
II级和III级精索静脉曲张会导致睾丸体积和精液质量下降，且与分级无关，但在评估射精液中前向运动精子的总数时，III级精索静脉曲张使这些青少年非常接近世界卫生组织的临界值，因此，目前治疗青少年精索静脉曲张的指南可能需要修订。
