Zampieri Nicola, Camoglio Francesco Saverio
Department of Pediatric Surgery, Paediatric Fertility Lab, Azienda Ospedaliera Universitaria Integrata, University of Verona, Woman and Child Hospital Piazzale A. Stefani 1, Verona, Italy.
Am J Clin Exp Urol. 2018 Jun 15;6(3):149-153. eCollection 2018.
Preserving the fertility potential of adolescent patients with varicocele is still the main outcome of pediatric and adolescent urologysts; the aim of this study is to assess the fertility potential of patients treated for varicocele with testicular hypotrophy in absence of post-operative complications, with complete ipsilateral testicular catch-up growth and normal hormonal values.
The Authors collected data from adolescents with varicocele aged between 10 and 16 years treated at their Institution between September 2010 and September 2015. Inclusion and exclusion criteria were created; all patients were followed clinically and with hormonal tests before and after surgery and then re-evaluated after semen analysis. Semen quality was correlated with hormonal status, surgical complications and testicular volume.
133 subjects without recurrences and with testicular catch-up growth were enrolled; at surgery 52 patients had grade III varicocele, 80 had grade II varicocele and 1 patient had grade I varicocele. Surgical complications at 18 months were 6 hydroceles (2 in grade III and 4 in grade II varicocele). Semen analysis was performed on 41 patients: 75% had a good semen quality, 9.7% fairly good semen quality and 14.6% poor semen quality. Considering grade III patients (12 subjects), 7 (58%) had good quality, 3 (25%) fairly good quality and the remaining 2 (16.6%) poor semen quality. In grade II patients, 23 (79.3%) had good quality, 4 (13.7%) fairly good quality and 2 (6.8%) had poor quality (P>0.05). There was no correlation between semen quality, hormonal status and pre-operative grade of varicocele and post-operative testicular volume.
The results demonstrate that varicocelectomy alone in well-studied and fully treated pediatric patients does not wholly preserve their fertility potential.
保留精索静脉曲张青少年患者的生育潜能仍是小儿和青少年泌尿外科医生的主要治疗目标；本研究的目的是评估在无术后并发症、同侧睾丸完全追赶生长且激素值正常的情况下，因精索静脉曲张伴睾丸萎缩而接受治疗的患者的生育潜能。
作者收集了2010年9月至2015年9月期间在其机构接受治疗的10至16岁精索静脉曲张青少年的数据。制定了纳入和排除标准；所有患者在手术前后均接受临床和激素检测，然后在精液分析后进行重新评估。精液质量与激素状态、手术并发症和睾丸体积相关。
纳入133例无复发且睾丸有追赶生长的受试者；手术时，52例患者为III级精索静脉曲张，80例为II级精索静脉曲张，1例为I级精索静脉曲张。18个月时的手术并发症为6例鞘膜积液（III级2例，II级4例）。对41例患者进行了精液分析：75%精液质量良好，9.7%精液质量尚可，14.6%精液质量差。考虑III级患者（12例受试者），7例（58%）质量良好，3例（25%）尚可，其余2例（16.6%）质量差。在II级患者中，23例（79.3%）质量良好，4例（13.7%）尚可，2例（6.8%）质量差（P>0.05）。精液质量、激素状态与术前精索静脉曲张分级及术后睾丸体积之间无相关性。
结果表明，在经过充分研究和全面治疗的小儿患者中，单纯精索静脉结扎术并不能完全保留其生育潜能。
