Department of Surgery, University of Pisa, Italy.
J Urol. 2010 Oct;184(4 Suppl):1722-6. doi: 10.1016/j.juro.2010.06.057. Epub 2010 Aug 21.
We report varicocele prevalence in adolescents. Surgical treatment has been proposed in adolescents with relevant testicular disproportion to avoid fertility problems in adulthood. We prospectively analyzed the testicular volume variation in adolescents with varicocele and hypoplastic testis.
In a 2-year period we selected 54 consecutive pediatric patients with a median age of 14.5 years (range 13 to 16) who had left varicocele using certain criteria, including testicular volume discrepancy greater than 20%, no previous inguinal-testicular surgery and no symptoms. Adolescents were divided into 2 groups, including 27 who underwent surgical correction with lymphatic sparing microsurgical varicocelectomy (intervention) and 27 who were only observed (control). After surgery or at first observation patients were evaluated clinically and by ultrasound at 3, 6 and 12 months. Testicular volume was estimated by the prolate ellipsoid formula.
We noted significant improvement in testicular volume with less than 20% disparity between the 2 gonads in 23 patients (85.2%) in the intervention group and in 8 controls (29.6%). Two recurrences (7.4%) were reported in the intervention group, each in an adolescent with increased testicular volume.
Our study confirms significantly increased testicular volume in many surgically treated boys and shows that physiological catch-up growth occurs in adolescents with varicocele without treatment. Considering critically results in each group, in select cases clinical and ultrasound followup is indicated before intervention due to a possible spontaneous decrease in testicular asymmetry. Further histopathological studies are needed to identify the relationship between testicular hypoplasia, irreversible damage and future fertility problems to determine which adolescents should be treated.
我们报告青少年精索静脉曲张的患病率。对于睾丸比例明显失调的青少年，已提出手术治疗以避免成年后生育问题。我们前瞻性分析了精索静脉曲张伴小睾丸的青少年睾丸体积的变化。
在 2 年期间，我们选择了 54 例符合特定标准的连续儿科患者，中位年龄为 14.5 岁（范围 13 至 16 岁），左侧精索静脉曲张，包括睾丸体积差异大于 20%，无先前腹股沟睾丸手术和无症状。青少年分为两组，包括 27 例接受保留淋巴的显微精索静脉曲张结扎术（干预组）和 27 例仅观察（对照组）。手术或首次观察后，患者在 3、6 和 12 个月时进行临床和超声评估。睾丸体积采用扁长椭球体公式估计。
我们发现干预组 23 例（85.2%）和 8 例对照组（29.6%）中睾丸体积差异小于 20%，睾丸体积明显改善。干预组报告了 2 例复发（7.4%），均发生在睾丸体积增加的青少年中。
我们的研究证实，许多接受手术治疗的男孩睾丸体积显著增加，并表明未经治疗的精索静脉曲张青少年会出现生理性追赶生长。考虑到每组的关键结果，在某些情况下，由于睾丸不对称可能会自发减小，在干预前需要进行临床和超声随访。需要进一步的组织病理学研究来确定睾丸发育不良、不可逆损伤和未来生育问题之间的关系，以确定哪些青少年需要治疗。
