Petrella Francis, Raymo Adele, Sadri Iman, Velasquez David, Madhusoodanan Vinayak, Deebel Nicholas, Bidhan Joginder, Nassau Daniel, Ramasamy Ranjith
Desai Sethi Urology Institute, University of Miami, Miami, Florida, USA.
Department of Urology, Nicklaus Children's Hospital, Miami, Florida, USA.
Andrology. 2024 Nov 5. doi: 10.1111/andr.13792.
Varicocele, a common vascular abnormality surrounding the testis, is known to be associated with impaired semen parameters and male infertility in adults. However, its impact on the adolescent and young adult (AYA) population is less well known.
The study aimed to assess the improvement in sperm parameters following varicocelectomy in the AYA population, comparing them to matched adult counterparts, and investigating potential advantages of early intervention.
A retrospective analysis was conducted using a comprehensive database at the University of Miami spanning from 2012 to 2023. We included AYA (under 25 years of age) men who underwent varicocelectomy. To ensure comparability, they were matched with adult patients (over 30 years of age) based on preoperative follicle-stimulating hormone (FSH) values and varicocele grade in a 1:2 ratio. Semen parameters were evaluated before and after surgery, including sperm count, motility, morphology, and overall semen quality.
We included 45 patients in the Adolescents and Young Adults (AYA) category, and matched them with 116 adults based on FSH and varicocele grade, all of whom underwent microsurgical varicocelectomy. The AYA group exhibited greater improvements post-varicocelectomy compared to the matched cohort. Furthermore, postoperative sperm concentration in the AYA men demonstrated a remarkable increase, with a 1.7-fold increase in mean concentration compared to the adult group (p < 0.001). Additionally, motility also displayed significant enhancement among the AYA men, with a final mean total motile sperm count (TMSC) improvement of 2.25-fold compared to the adult cohort (p = 0.002).
This study highlights the potential benefits of varicocelectomy as a viable treatment option for adolescents and young adults with varicocele, particularly those with impaired semen parameters. By intervening at an earlier stage of development, patients in this age group can achieve significant improvements in semen quality, as compared to their adult counterparts.
These findings underscore the importance of considering varicocelectomy as a valuable therapeutic approach for the younger demographic, potentially alleviating future fertility concerns.
精索静脉曲张是睾丸周围常见的血管异常，已知与成年男性精液参数受损和男性不育有关。然而，其对青少年和青年（AYA）人群的影响鲜为人知。
本研究旨在评估AYA人群精索静脉曲张切除术后精子参数的改善情况，与匹配的成年男性进行比较，并探讨早期干预的潜在优势。
利用迈阿密大学2012年至2023年的综合数据库进行回顾性分析。纳入接受精索静脉曲张切除术的AYA（25岁以下）男性。为确保可比性，根据术前促卵泡激素（FSH）值和精索静脉曲张分级，按1:2的比例将他们与成年患者（30岁以上）进行匹配。在手术前后评估精液参数，包括精子数量、活力、形态和整体精液质量。
我们纳入了45例青少年和青年（AYA）患者，并根据FSH和精索静脉曲张分级将他们与116例成年患者进行匹配，所有患者均接受了显微外科精索静脉曲张切除术。与匹配队列相比，AYA组在精索静脉曲张切除术后表现出更大的改善。此外，AYA男性术后精子浓度显著增加，平均浓度比成年组增加了1.7倍（p < 0.001）。此外，AYA男性的活力也有显著提高，最终平均总活动精子数（TMSC）比成年队列提高了2.25倍（p = 0.002）。
本研究强调了精索静脉曲张切除术作为精索静脉曲张青少年和青年患者可行治疗选择的潜在益处，特别是那些精液参数受损的患者。与成年患者相比，通过在发育早期进行干预，该年龄组的患者精液质量可得到显著改善。
这些发现强调了将精索静脉曲张切除术视为年轻人群有价值的治疗方法的重要性，这可能减轻未来的生育担忧。
