Semen analysis in patients treated for varicocele in pediatric age: are surgical outcomes enough to preserve the fertility potential?

UNLABELLED

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

The results demonstrate that varicocelectomy alone in well-studied and fully treated pediatric patients does not wholly preserve their fertility potential.