Pinto K J, Kroovand R L, Jarow J P
Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
J Urol. 1994 Aug;152(2 Pt 2):788-90. doi: 10.1016/s0022-5347(17)32710-6.
Varicoceles are the most common reversible cause of male factor infertility, yet approximately 80% of men with varicoceles are fertile. Therefore, it is unclear whether all adolescents should undergo prophylactic varicocelectomy to prevent future infertility or whether a subgroup of patients who are at increased risk for future infertility can be identified and treated. Testicular size discrepancy or hypotrophy of the testis associated with a unilateral varicocele has been suggested as an indication for prophylactic varicocelectomy in adolescents. We examined 946 men attending a urological clinic for complaints other than infertility to determine whether testis size discrepancy was predictive of infertility in men with left varicoceles. A left varicocele was detected on physical examination in 211 men, of whom 173 (82%) had been able to father children and 38 (18%) had never fathered children. A group of 630 men without palpable varicoceles served as controls, including 528 (84%) with a history of fertility. Testicular size was measured using an orchidometer and the average testicular volume difference was obtained by subtracting left from right testicular volume. The mean testicular volume difference for the fertile men without varicoceles (1.6 +/- 0.3 ml.) was significantly lower than the fertile men with varicoceles (3.1 +/- 0.4 ml.) (p < 0.05) and infertile men with varicoceles (2.5 +/- 0.6 ml.) (p < 0.05). There was no significant difference between fertile and infertile men with varicoceles. This study confirms prior reports that the majority of men with left varicoceles are able to father children and that varicoceles cause significant ipsilateral testicular atrophy/hypotrophy. However, we were unable to demonstrate a correlation between loss of testicular volume and fertility status in men with left varicoceles. Further study is needed to identify the clinical parameters predictive of future infertility in adolescents with varicoceles.
精索静脉曲张是男性因素不育最常见的可逆病因，但约80%患有精索静脉曲张的男性仍具有生育能力。因此，目前尚不清楚所有青少年是否都应接受预防性精索静脉结扎术以预防未来的不育症，或者是否可以识别并治疗未来不育风险增加的亚组患者。与单侧精索静脉曲张相关的睾丸大小差异或睾丸萎缩已被建议作为青少年预防性精索静脉结扎术的指征。我们检查了946名因不育以外的原因前往泌尿外科门诊就诊的男性，以确定睾丸大小差异是否可预测左侧精索静脉曲张男性的不育情况。体格检查发现211名男性存在左侧精索静脉曲张，其中173名（82%）已育有子女，38名（18%）从未育有子女。一组630名未触及精索静脉曲张的男性作为对照，其中528名（84%）有生育史。使用睾丸计测量睾丸大小，并通过右侧睾丸体积减去左侧睾丸体积获得平均睾丸体积差异。无精索静脉曲张的可育男性的平均睾丸体积差异（1.6±0.3 ml）显著低于有精索静脉曲张的可育男性（3.1±0.4 ml）（p<0.05）和有精索静脉曲张的不育男性（2.5±0.6 ml）（p<0.05）。有精索静脉曲张的可育和不育男性之间无显著差异。本研究证实了先前的报道，即大多数左侧精索静脉曲张的男性能够生育子女，且精索静脉曲张会导致同侧睾丸明显萎缩/变小。然而，我们未能证明左侧精索静脉曲张男性的睾丸体积减少与生育状况之间存在相关性。需要进一步研究以确定可预测精索静脉曲张青少年未来不育的临床参数。
