Buch J P, Cromie W J
Urol Clin North Am. 1985 Feb;12(1):3-12.
Varicocele is the most common surgically correctable cause of male infertility. In adult patients with varicocele and infertility, pregnancy rates following varicocelectomy range as high as 55 per cent in comparison with a pregnancy rate of only 7 per cent in unoperated controls. The initial presentation of varicocele occurs during puberty with the incidence in 13-year-old boys already equivalent to that in the general male population. This occurrence has been referred to as the childhood or adolescent varicocele. Varicocele is a progressive disorder in many if not in all cases, with an obvious individual variation in the time course of progression. The effects of a unilateral lesion are often noted in the contralateral testis. Based upon present knowledge, it is not possible to predict accurately the time course of progression in individual cases of childhood varicocele. However, significant prognostic features in adolescents with varicocele include the following: (1) testicular atrophy, or arrested testicular growth; (2) high-grade varicocele (grade II or III); (3) bilateral lesions; (4) pathologic GnRH stimulation test; and (5) histologic picture of Leydig-cell hyperplasia. The presence of these features either alone or in combination is an indication for treatment in our hands. Unlike adults with varicocele, it is not practical to follow children and adolescents with spermatograms.(ABSTRACT TRUNCATED AT 250 WORDS)
精索静脉曲张是男性不育最常见的可通过手术矫正的病因。在患有精索静脉曲张和不育症的成年患者中，精索静脉结扎术后的妊娠率高达55%，而未手术对照组的妊娠率仅为7%。精索静脉曲张最初出现在青春期，13岁男孩的发病率已与普通男性人群相当。这种情况被称为儿童期或青春期精索静脉曲张。在许多（即使不是所有）病例中，精索静脉曲张是一种进行性疾病，其进展时间过程存在明显的个体差异。单侧病变的影响常常在对侧睾丸中被观察到。根据目前的知识，不可能准确预测儿童期精索静脉曲张个体病例的进展时间过程。然而，精索静脉曲张青少年的显著预后特征包括以下几点：（1）睾丸萎缩或睾丸生长停滞；（2）重度精索静脉曲张（II级或III级）；（3）双侧病变；（4）病理性促性腺激素释放激素刺激试验；（5）睾丸间质细胞增生的组织学表现。这些特征单独或组合存在是我们进行治疗的指征。与成年精索静脉曲张患者不同，对儿童和青少年进行精子图检查并不实际。（摘要截断于250字）
