Cicigoi A, Bianchi M
Divisione di Urologia Pediatrica, Ospedale Infantile Regina Margherita, Torino.
Arch Ital Urol Nefrol Androl. 1991 Dec;63(4):409-13.
Varicocele normally presents itself in adolescence, with an incidence of 16 per cent. Less than one third of the boys, though, will suffer from male infertility in adulthood. Therefore, it seems excessive as well as imprudent to suggest surgery to all those patients. We worked out some parameters to identify "risky" cases of varicocele. From June to November 1990 we studied 45 patients from 10 to 16 years of age affected by varicocele, taking into consideration the following factors: puberal phase, symptomatology, degree of varicocele, testicular volume, Doppler ultrasound, hormonal profile. A Doppler ultrasound test evidenced a clinically undetected right reflux, in addition to a left varicocele, in 13 patients (34.4%). Sixty per cent of these 13 patients revealed a pathological response to LHRH test; this incidence is very close to that evidence in clinical bilateral varicocele. We believe that a right reflux showed by ultrasounds, represents a cause of further alteration in the patient's endocrinological balance in addition to increasing his risk of infertility. Purpose of this study was to draw a guideline for early diagnosis, correct treatment and follow-up of varicocele in peripubertal age.
精索静脉曲张通常在青春期出现，发病率为16%。然而，成年后只有不到三分之一的男孩会患男性不育症。因此，建议对所有这些患者进行手术似乎既过度又不谨慎。我们制定了一些参数来识别精索静脉曲张的“高危”病例。1990年6月至11月，我们研究了45名年龄在10至16岁之间患有精索静脉曲张的患者，考虑了以下因素：青春期阶段、症状、精索静脉曲张程度、睾丸体积、多普勒超声、激素水平。多普勒超声检查发现，除左侧精索静脉曲张外，13名患者（34.4%）临床上未检测到的右侧反流。这13名患者中有60%对促黄体生成素释放激素（LHRH）试验显示出病理反应；这一发生率与临床双侧精索静脉曲张的证据非常接近。我们认为，超声显示的右侧反流除了增加患者不育的风险外，还代表了患者内分泌平衡进一步改变的一个原因。本研究的目的是为青春期前后精索静脉曲张的早期诊断、正确治疗和随访制定一个指南。
