Kass E J, Reitelman C
Division of Pediatric Urology, William Beaumont Hospital, Royal Oak, Michigan.
Urol Clin North Am. 1995 Feb;22(1):151-9.
Currently, we recommend varicocele repair in adolescents when (1) the results of semen analysis are abnormal, (2) the volume of the left testis is at least 3 mL less than that of the right, (3) the response of either luteinizing hormone or FSH to Gn-RH stimulation is supranormal, (4) bilaterally palpable varicoceles are detected, or (5) a large symptomatic varicocele is present. When surgery is necessary, the Palomo approach significantly decreases the risk of operative failure and has facilitated "catch-up" growth of the left testis that is comparable to that after artery-sparing procedures. It is important to note that there is potential for impaired fertility whenever a palpable varicocele is present. Unfortunately, no test or group of tests can predict with absolute certainty whether an adolescent with a varicocele will be fertile or infertile. Therefore, it is important to observe untreated patients until they complete their families. Patients who are unwilling or unable to adhere to the follow-up protocol may be candidates for surgical intervention.
目前，我们建议在以下情况时对青少年进行精索静脉曲张修复术：（1）精液分析结果异常；（2）左侧睾丸体积比右侧至少小3毫升；（3）黄体生成素或促卵泡激素对促性腺激素释放激素刺激的反应超常；（4）双侧可触及精索静脉曲张；或（5）存在有症状的大型精索静脉曲张。当需要手术时，帕洛莫手术方法可显著降低手术失败的风险，并促进左侧睾丸的“追赶性”生长，这与保留动脉的手术术后情况相当。需要注意的是，只要存在可触及的精索静脉曲张，就有可能损害生育能力。不幸的是，没有任何一项检查或一组检查能够绝对确定地预测患有精索静脉曲张的青少年将来会生育还是不育。因此，观察未经治疗的患者直至他们组建家庭很重要。不愿意或无法遵守随访方案的患者可能适合进行手术干预。
