Podesta M L, Gottlieb S, Medel R, Ropelato G, Bergada C, Quesada E M
Department of Surgery, University of Buenos Aires, Argentina.
J Urol. 1994 Aug;152(2 Pt 2):794-7; discussion 798. doi: 10.1016/s0022-5347(17)32712-x.
Preoperative and postoperative testicular volume, serum testosterone, follicle-stimulating hormone and luteinizing hormone were determined in 25 patients 8 to 19 years old (mean age 13.2 +/- 1.63) with grades 2 and 3 unilateral varicocele. Testicular growth arrest was considered significant when volume loss was greater than 2 ml. in the ipsilateral testis compared to the contralateral side. Baseline serum testosterone, follicle-stimulating hormone and luteinizing hormone as well as post-gonadotropin releasing hormone stimulation were determined preoperatively and at 4 to 6 months postoperatively. Data are presented as mean plus or minus standard deviation. Results showed an increase in serum testosterone in Tanner's stages 1 (p < 0.028) and 2 to 3 (p < 0.008). No differences were recorded in basal luteinizing hormone and follicle-stimulating hormone, as well as maximal follicle-stimulating hormone levels before and after surgery. A decrease of maximal luteinizing hormone response to gonadotropin releasing hormone test was noted postoperatively in pubertal stages 4 to 5, when compared to preoperative values. Postoperative ipsilateral testicular volume increased in all Tanner stages (p < 0.045, p < 0.008 and p < 0.012, respectively). Our observations suggest that varicocele may be initially responsible for interstitial dysfunction with preservation of germinal function and unilateral testicular growth arrest, however reversible, after pubertal surgical correction. This study supports previous reports suggesting that varicocelectomy in children who show anatomic and functional changes is advisable.
对25例8至19岁（平均年龄13.2±1.63岁）患有2级和3级单侧精索静脉曲张的患者，测定其术前和术后的睾丸体积、血清睾酮、促卵泡激素和促黄体生成素。当患侧睾丸体积较对侧减少超过2 ml时，认为睾丸生长停滞具有显著性。术前及术后4至6个月测定血清睾酮、促卵泡激素和促黄体生成素的基线水平以及促性腺激素释放激素刺激后的水平。数据以平均值加减标准差表示。结果显示，坦纳1期（p < 0.028）以及2至3期（p < 0.008）的血清睾酮有所升高。术前和术后基础促黄体生成素、促卵泡激素以及最大促卵泡激素水平均无差异。与术前值相比，4至5期青春期患者术后促性腺激素释放激素试验的最大促黄体生成素反应有所下降。所有坦纳分期的术后患侧睾丸体积均增加（分别为p < 0.045、p < 0.008和p < 0.012）。我们的观察结果表明，精索静脉曲张最初可能导致间质功能障碍，同时保留生精功能，并导致单侧睾丸生长停滞，不过在青春期手术矫正后这种情况是可逆的。本研究支持先前的报道，即对出现解剖学和功能改变的儿童进行精索静脉结扎术是可取的。
