The effect of varicocele repair on testicular volume in children and adolescents with varicocele

PURPOSE: We investigated the effect of varicocele repair on testicular volume according to age in children and adolescents and review the long-term results of varicocele surgery. MATERIALS AND METHODS: The study included 39 boys 11 to 19 years old with clinical palpable varicocele who underwent varicocele surgery with at least 1 year of postoperative followup. Preoperative and postoperative testicular volumes were monitored and measured with an ellipsoid Prader orchidometer. Physical examination findings (testicular volumes and testicular consistency) in all boys, and serum hormone values and semen parameters in 16 adolescents were recorded and compared before and after surgery. RESULTS: Left unilateral varicocelectomy was done in 29 boys (74%) and bilateral varicocelectomy in 10 (26%). While no postoperative hematoma, infection or testicular atrophy was observed, 1 boy (2.5%) had varicocele recurrence and 2 boys (5.1%) had minimal hydroceles that required no intervention. Significant increases were observed in postoperative sperm concentration (p = 0.01), total motile sperm count (p = 0.009), testis volume (p = 0.000) and serum testosterone level (p = 0.014). All 15 boys with preoperative soft testis had normal testicular consistency postoperatively. Of the 19 boys with preoperative testicular atrophy 10 (53%) did regain normal testicular growth, while 9 (47%) retained testicular volume loss after surgery. When comparing preoperative to postoperative increase in testicular volume according to age in all boys, the mean was statistically significantly higher in boys younger than 14 years (left testis p = 0.037, right testis p = 0.000). CONCLUSIONS: Testicular consistency achieved normal firmness after varicocelectomy in all boys with preoperative soft testis. While there was catch-up growth in comparison to the contralateral testis, testicular consistency improved but testicular volumes may not increase significantly after varicocele repair at ages older than 14 years. However, in these adolescents postoperative semen parameters and serum hormone values may significantly improve regardless of testicular volume. Therefore, boys with varicocele and their families should be fully informed in light of these findings.     

男性不育患者精索静脉曲张的超声诊断研究

目的:探讨高频超声诊断男性不育患者精索静脉曲张(varicocele,VC)的检测指标及其VC导致睾丸体积改变情况。方法:采用高频超声方法对46例正常对照者的精索静脉及178例男性不育患者左侧曲张的精索静脉进行了检测。根据临床及超声检查结果将178例VC患者分为4组,其中亚临床型VC(SVC)组45例,临床型VCⅠ级(VCⅠ)组44例,Ⅱ级(VCⅡ)组48例,Ⅲ级(VCⅢ)组41例。结果:①对照组双侧平静呼吸时精索静脉最大内径(DR)、Valsalva试验时精索静脉最大内径(DV)、最大返流速度(Vmax)、返流持续时间(TR)及睾丸体积差别均无显著性(P>0.05);②VC组与对照组及各级VC组DR、DV、Vmax、TR比较的差别具有显著性(P<0.001);③各VC组左侧睾丸体积小于右侧(P<0.01),VCⅡ、VCⅢ组右侧睾丸体积小于对照组(P<0.05),VCⅢ组左侧睾丸体积小于SVC组(P<0.05)。结论:①高频超声可为男性不育VC患者提供精确的精索静脉内径、血流动力学及睾丸大小等客观指标,有助于男性不育病因的筛选;②单侧VC可引起双侧睾丸体积变小,尤以左侧为甚,亚临床型及临床型VC均可导致患侧睾丸体积缩小,且VC愈严重,睾丸体积愈小。     

THE ADOLESCENT VARICOCELE I: LEFT TESTICULAR HYPERTROPHY FOLLOWING VARICOCELECTOMY

PURPOSE: Ipsilateral testicular catch-up growth has been reported to occur in approximately 80% of adolescents with varicoceles following unilateral varicocelectomy. We have been observing not only catch-up growth, but hypertrophy (left at least 10% larger than right testicular volume) in some adolescents postoperatively. To our knowledge this phenomenon has not been previously described. We assess the incidence of left testicular hypertrophy following ipsilateral varicocele ligation and whether it is related to age at operation and/or procedure performed. MATERIALS AND METHODS: We reviewed the records of 42 patients who underwent unilateral left varicocelectomy for asymptomatic varicoceles. Testicular volume was determined before and after surgery, and all patients were followed for a minimum of 6 months. Indication for surgery was ipsilateral left testicular hypotrophy in 23 cases, grade 2 to 3 varicocele with palpably softer ipsilateral left testicle in 5, grade 3+ varicoceles in 12, an exaggerated response to gonadotropin-releasing hormone stimulation test in 1 and persistent pain in 1. Average patient age at operation was 14.7 years (range 9 to 22) and average followup was 22 months (range 6 to 84). Patients were stratified according to Palomo versus modified Ivanissevich technique and age at operation. Testes were measured using the Takihara ring orchidometer with relative volume of the left testis expressed as a percentage of the right testis. Results were compared in different age groups as well as by procedure performed to correct the varicocele using chi-square analysis. RESULTS: Left testicular hypertrophy developed in 13 of 32 patients (43.8%) who underwent a Palomo repair and in 3 of the 10 (30%) who underwent a modified Ivanissevich repair. When compared by age at operation, 8 of 20 patients (40%) 14.7 years old or younger had left testicular hypertrophy compared to 8 of 22 (36.4%) older than 14.7 years. Differences between these groups were not statistically significant. CONCLUSIONS: Ipsilateral testicular hypertrophy occurs in a substantial number of adolescents following varicocele ligation. This phenomenon does not seem to be dependent on age at surgery or type of varicocele repair.     

The effects of experimental varicocele on testicular histology and fertility in monorchic adult rats

OBJECTIVE: To determine the effects of a left-sided experimental varicocele on testicular morphology and fertility in right hemicastrated adult rats. MATERIALS AND METHODS: A double-controlled experimental study was carried out using mature Sprague-Dawley rats, with 12 rats in each treated group and five corresponding controls. Group 1 underwent right orchidectomy, group 2 right orchidectomy and a left varicocele, and group 3 only a left varicocele; each control group underwent a corresponding sham operation. Two months after surgery each rat was placed with two mature female rats for one month to assess fertility. All the rats were then killed and their testes weighed; the mean testicular weight was calculated for each group and the mean seminiferous tubule diameter (STD) measured. Johnsen scores and histological abnormalities were evaluated for each testis using light microscopy. RESULTS: The mean (SEM) testicular weight and STD in group 2 were significantly lower, at 1311 (100) mg and 225 (11) microm, respectively, than in group 1, at 1771 (28) mg and 255 (4) microm (P<0.05). The mean weights of both testes in rats in group 3 were significantly lower than those in group 1 (P<0.05) and although both mean STDs were less than in group 1, the differences were not significant (P>0.05). There were no differences between the Johnsen scores in groups 2 and 3. There were severe histological abnormalities in the left testes in three of nine and two of eight animals in group 2 and 3, respectively; in group 3, changes in the right testis were detected in one rat. Six of nine and seven of eight rats were fertile in group 2 and 3, respectively. CONCLUSION: Experimental left varicocele decreased the left testicular weight and STD in both hemicastrated and intact adult rats. However, the presence of the right testis is important for preserving fertility.     

COMPARISON OF BILATERAL VERSUS UNILATERAL VARICOCELECTOMY IN MEN WITH PALPABLE BILATERAL VARICOCELES

PURPOSE: The left varicocele is usually larger in men with bilateral varicoceles. We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele. To test this hypothesis we prospectively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large (grade III) or moderate (II) left varicocele associated with small but palpable (I) right varicocele. MATERIALS AND METHODS: A total of 91 patients were prospectively followed and included in the study. Of the patients 65 underwent bilateral and 26 underwent unilateral left repair. All patients underwent preoperative and postoperative semen analysis. RESULTS: Motile sperm concentration increased from 12.1+/-1.7 to 23.7+/-31.8 (95.8% change) in the bilateral group compared with an increase from 19.5+/-21.4 to 27.8+/-34.8 (42.6% change) in the unilateral group (p<0.05). Similarly, sperm concentration increased from 23.8+/-29.5 to 48.6+/-61.3 (157.6% change) in the bilateral group compared with an increase from 41.1+/-40.9 to 59.5+/-66.7 (44.8% change) in the unilateral group (p<0.05). CONCLUSIONS: Bilateral varicocelectomy resulted in significantly greater improvement in post-operative seminal parameters than unilateral repair in patients with grades II to III left varicocele associated with grade I right varicocele. Even a small, unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function. Men with bilateral palpable varicoceles require bilateral repair.     

Effects of grade 1 varicocele detected in the pediatric age-group on testicular development

Purpose

A number of reports have indicated the effectiveness of varicocelectomy on large varicoceles in adolescents. We carried out a 5-year follow-up study to examine the effect of grade 1 varicocele on testicular development.

Methods

Of 31 boys with left grade 1 varicocele (mean age, 12.6 years), 10 underwent microsurgical varicocelectomy and 21 were conservatively observed and evaluated for testicular volume and varicocele grade. The control group consisted of 20 healthy age-matched boys without a varicocele. The mean relative left testicular volume was compared with the right testis and the absolute bilateral testicular volumes among the boys in all groups.

Results

Of 21 boys who were observed, 13 (62%) continued to have grade 1 varicocele, 4 (19%) developed grade 2 varicocele, and the other 4 boys (19%) showed spontaneous resolution. Twelve testes (57%) developed in parallel with the right testis, and 1 boy (5%) who experienced spontaneous resolution of the varicocele had catch-up testicular growth, whereas 8 boys (38%) had left testicular growth delay with or without an increasing grade of varicocele. Varicocelectomy, but not observation, improved the previously noted testicular growth delay. Furthermore, right testicular growth delay was also noted during observation.

Conclusions

More than half of the total number of boys with grade 1 varicocele showed normal development, whereas many boys presented with growth delay in both testes. Thus, we still need to define reliable predictors that will permit selection of the best candidates for varicocelectomy.     

Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume: using the prader orchidometer versus ultrasonography

INTRODUCTION: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. PATIENTS AND METHODS: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. RESULTS: The mean age of the boys was 13.5 +/- 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). CONCLUSIONS: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.     

Ⅲ度精索静脉曲张患者显微结扎术后生精功能的变化

目的：研究Ⅲ度精索静脉曲张显微结扎术后生精功能的变化,以探讨手术的价值.方法：选择Ⅲ度精索静脉曲张并男性不育患者118例,观察其显微结扎术前后睾丸体积、精子密度、活率、形态、血清卵泡刺激素（FSH）、睾酮（T）及抑制素B浓度的变化.结果：患者手术6个月后的左侧睾丸体积（P〈0.05）、精子密度（P〈0.01）及活率（P〈0.05）均明显提高,血清FSH水平明显降低（P〈0.05）,T（P〈0.01）及抑制素B（P〈0.05）水平明显提高.而睾丸体积及精子形态无显著变化.结论：显微结扎术能改善Ⅲ度精索静脉曲张患者的生精功能.     

Testicular hypotrophy does not correlate with grade of adolescent varicocele

PURPOSE: Testicular hypotrophy is the most widely accepted indication for correcting adolescent varicocele. Previous studies in adolescents have shown a relationship between increasing grade of varicocele and the likelihood of testicular hypotrophy. As this relationship has significant clinical implications, we studied the correlation between grade and testicular volume disproportion in our adolescent varicocele population. MATERIALS AND METHODS: We reviewed the adolescent varicocele database at our institution. A total of 168 patients 8 to 21 years old were studied. We routinely calculated testis volumes using scrotal ultrasound. Testicular disproportion was calculated using the equation [(size of unaffected testis) - (size of affected testis)]/(size of unaffected testis) x 100%. Disproportion was categorized as less than 10%, 10% to 20% and more than 20%. Varicoceles were graded by an attending urologist with the patient standing, using the system of Dubin and Amelar. Analysis of variance and Pearson chi-square indicated no significant differences in volume differential between varicocele grades. RESULTS: Mean +/- SD volume differential was 18% +/- 15% for grade I, 25% +/- 20% for grade II and 19% +/- 14% for grade III. ANOVA revealed no significant difference in mean volume differential between the 3 varicocele grades (p = 0.10). When categorizing patients into 3 levels of volume differential (less than 10%, 10% to 20%, more than 20%) no significant correlation was observed between varicocele and volume differential (p = 0.48, chi-square test). CONCLUSIONS: Grade of varicocele does not correlate with presence or severity of testicular disproportion in adolescent boys with varicocele as measured by scrotal ultrasound.     

Effect of adult microsurgical varicocelectomy on testicular volume

OBJECTIVES: To re-examine the potential influence of varicocelectomy on testicular volume using scrotal ultrasonography, because it has been reported that total testicular volume (assessed by physical examination) increases after adult varicocele ligation. METHODS: A retrospective review of the testicular volume and semen parameters of 61 men who underwent microsurgical varicocelectomy between 1996 and 1998 was performed. Ultrasound-derived testicular volumes and total motile sperm counts were compared before varicocelectomy and at a mean of 7.2 months postoperatively. RESULTS: Bilateral varicocelectomy was performed in 22 men; 39 men underwent a left-sided procedure only. Overall, no significant change was found in the mean total testicular volume after varicocelectomy compared with preoperatively (24.0 versus 23.9 mL, respectively; P = 0.74). Similarly, the testicular volumes did not change significantly after left or bilateral varicocelectomy (P >0.05). Overall, the mean total motile sperm count increased significantly after varicocelectomy (17. 9 to 25.4, P = 0.05). CONCLUSIONS: This was the first study to examine the effect of adult varicocelectomy on testicular volume using ultrasound-derived measurements of volume. Unlike previous findings, our data suggest that although adult varicocelectomy improves semen quality in most infertile men, it does not result in a significant increase in testicular volume.     

Recurrences, testicular growth and semen parameters after laparoscopic Palomo varicocelectomy

The aim of this study was to evaluate the influence of laparoscopic Palomo varicocelectomy on testicular volume and sperm parameters. Laparoscopic Palomo varicocelectomy was performed on 91 patients for left-sided grade II and grade III varicoceles. Ultrasound-derived testicular volumes, semen volume, sperm concentration, percentage sperm motility and total motile sperm count were compared before and after the procedure. Postoperative complications and recurrence rate were also assessed. There were no surgical complications. Four patients (5%) had a mild hydrocele, but did not need hydrocelectomy. No patients presented signs of testicular atrophy and the left testicular volume increased in the adolescents (p < 0.05), but not in the adults. Our data suggest that laparoscopic high mass ligation of both the testicular artery and vein is a highly effective, reliable method for the treatment of varicocele. It is associated with very low complication and recurrence rates and with an objective improvement in fertility parameters.     

Relationship between testicular volume and presence of varicocele. A comparative study

The varicocele, present in many of the male partners of infertile couples continues to generate controversy, particularly as related to its diagnosis and pathophysiology. The purpose of our study was to determine the relationship between testicular volume and the presence or absence of a varicocele. Testicular volume was determined by the use of an orchiometer; the presence of a varicocele was determined by palpation during a Valsalva maneuver. The patients utilized in the study were those seen in our Andrology and General Urology Clinics; 291 patients with varicoceles and 83 control patients (no evidence of varicocele) were used. The left (mean = 21.4 mL) and right (mean = 23.4 mL) testicular volumes of patients with a varicocele were significantly reduced compared with that of the control group (left, mean = 23.4 mL; right, mean = 26.2 mL; p = 0.0041 and p = 0.002, respectively). The testicular volume corrected on the basis of the body mass (V/m2) also was significantly reduced in the varicocele group compared with controls (left p = 0.007; right p = 0.001). Reduced testicular volume relative to body size may be detected prior to actual demonstration of the stress pattern and the presence of a varicocele, and may be useful in early diagnosis. It is suggested that measurement of testicular volume may be a useful adjunct to routine examination of the infertile male.     

Clinical assessment after varicocelectomy

The present study, conducted in Hong Kong, was designed to evaluate the clinical assessment and interobserver variation between doctors with different levels of training in the assessment of recurrent varicoceles, and to compare their findings with those made by ultrasound. Fifteen patients, previously operated for left varicocele testis, were evaluated clinically by four observers. The mean age was 12.9 years (range 8-15 years) at surgery. The testicular texture, size and flow with and without the Valsalva manoeuvre were determined by colour Doppler sonography. The follow-up time was 6-48 months after surgery. The echotexture of the testes was normal in all patients. The mean volumes of the left and right testes were equal after surgery (left 9.0 ml [range 2.4-15.2 ml and right 8.7 ml [range 3.4-15.6 ml]). There was large variation between observers in the predictability of both positive and negative clinical findings of varicocele testis when compared with ultrasound. Objective assessment in grading varicocele testis and testicular volume using ultrasound is required for both clinical management and scientific research.     

Varicocele in schoolboys

This study was conducted to examine the effect of height and weight on the incidence of varicocele in schoolboys aged 5-16 years and the impact of varicocele on testicular size. Genital stage, height, weight, varicocele grade, and testicular size were recorded for 3047 school boys who were clinically examined while standing by a specialist in urology. Left varicocele was detected in 98 of the boys who were all aged 9-16 years. The mean weight of boys with and without varicocele was 42 kg (95% confidence interval [CI] 40-44 kg) and 47 (95% CI 47-47 kg), respectively (p =.00). There was no difference in mean height between the two groups nor in left and right testicular volume. Although 6 boys with varicocele had a left testicular volume > or =2 mL less than right, there were also 7 boys of comparable age who had a left testicular volume > or =2 mL larger than right. The incidence of varicocele in Greek adolescents is low. Boys with varicocele weighed significantly less but there were no significant differences in height or left versus right testicular volumes. In the light of these observations, the use of left testicular hypotrophy (> or =2 mL compared with the right testicle) should be reconsidered as an indicator for varicocele-induced damage of the testicle in this age group.     

Comparison of the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain

We investigated the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain. We retrospectively reviewed the records of patients who underwent varicocelectomy. The age, body mass index, grade, laterality of varicocele, testicular volume difference, time to hospital visit, serum testosterone level and semen parameters were evaluated. A total of 954 patients were included. The painful group had lower mean age, lower BMI, higher grade of varicocele, smaller testicular volume difference and shorter time to hospital visit than the painless group. In addition, the median serum total testosterone level and total sperm count, concentration and motility were higher in the painful group than in the painless group. In multivariate analysis, there were significant differences between the two groups in age, grade of varicocele, testis volume difference, time to hospital visit, total sperm count and concentration. Patients with painful varicocele visited hospital earlier because of the pain and tended to start treatment sooner. They were also younger, had smaller testis atrophy and had higher sperm concentration, even though they had a higher grade of varicocele than patients without pain. Although scrotal pain in varicocele patients is difficult to treat, it leads to early diagnosis and treatment.     

Radiologically assessed testicular changes in infertile males with varicocele

The aim of this study was to assess vascular disturbances in the testis of infertile males associated with varicocele. In total, 124 consecutive male subjects were divided into the following groups: healthy fertile controls (n = 10), Gp1 (n = 28); infertile males with subclinical varicocele, Gp2 (n = 26); infertile males with grade I left varicocele, Gp3 (n = 28); infertile males with grade II left varicocele and Gp4 (n = 32); infertile males with grade III left varicocele. They were subjected to colour duplex for pampiniform plexus and scrotal scintigraphy. There was significant decrease in arterial blood velocity, testicular arterial diameters and testicular perfusion especially in high grade varicocele compared with healthy controls. The mean vein diameter demonstrated significant negative correlation with arterial diameter, arterial blood velocity, perfusion index, testicular size and significant positive correlation with perfusion index. The mean testicular size demonstrated significant positive correlation with arterial blood velocity, perfusion index and nonsignificant correlation with arterial diameter. It is concluded that there are significant decreases in testicular volume, testicular perfusion, blood velocity and testicular artery diameter in infertile males with varicocele.     

Antegrade scrotal sclerotherapy for treating primary varicocele in children

OBJECTIVE: To evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood. PATIENTS AND METHODS: From December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9-18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left-sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow-up of 11 (3-60) months, and the operative duration, X-ray exposure time, persistence rate of varicoceles and complications were compared with those using other techniques. RESULTS: In 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume (<75% testicular volume vs the normal side) confirmed by US. The mean (sem) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty-four (97%) patients were eligible for follow-up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow-up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis). CONCLUSIONS: AS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication.     

Therapeutic strategy after microsurgical varicocelectomy in the modern assisted reproductive technology era

In this study, we searched for prognostic factors at preoperative examination for the improvement in spermatogenesis of patients undergoing varicocelectomy.Eighty patients with varicocele testis underwent microsurgical varicocelectomy. Before surgery, the seminogram, testicular volume, varicocele grade, and serum FSH, LH, testosterone, prolactin, and estradiol were evaluated. Postoperatively, semen analysis was performed every 3 months. We assessed the associations between the preoperative variables and postoperative seminogram improvement. 0f 80 patients, 37 showed improvement, usually by 6 months. Patient age, duration of sterility, testicular volume, sperm motility, morphology, semen volume, serum LH, testosterone, prolactin, and estradiol showed little difference between responders and non-responders. A small left testis, or a grade III varicocele decreased the likelihood of improvement. Patients with a sperm count of 10-20 x 10(6)/ml were significantly more likely to respond to varicocelectomy than those with sperm counts <5 x 10(6)/ml. Patients with elevated FSH were less likely to respond, as were those with a Johnsen score below 6. Varicocelectomy alone is unlikely to improve sperm counts of patients with a sperm count below 5 x 10(6)/ml, high FSH, small left testes, or Johnsen scores below 6. In conclusion, for couples in this situation, assisted reproductive technology coupled with varicocelectomy should be proposed.     

Effect of experimental varicocele in rats on testicular oxidative stress status

The present experiments were undertaken to determine the levels of MDA, SOD and catalase in the testis of adolescent rats with experimental left varicoceles. Male Wistar rats, 7 weeks old and weighing 160-170 g, were randomly allocated into three groups. The first group of rats underwent partial ligation of the left renal vein (n = 15). The second group of rats underwent a sham operation (n = 7) and the third group acted as controls (n = 7). Animals were sacrificed 6 weeks after surgery and dilatation of the internal spermatic veins was observed. Levels of MDA, SOD and catalase activity were measured in testis. The experimental left varicocele group showed severe testicular changes compared to other groups. The mean MDA (SEM) levels in right and left testicular tissues of varicocele bearing rats, sham-operated rats, and control rats were 0.48 +/- 0.24 and 0.31 +/- 0.11, 0.22 +/- 0.02 and 0.35 +/- 0.12, 0.62 +/- 0.29 and 0.13 +/- 0.05, respectively (P > 0.05). The mean SOD (SEM) levels in right and left testicular tissues of varicocele bearing rats, sham-operated rats, and control rats were 7,790 +/- 606 and 6,974 +/- 574, 7,475 +/- 1,517 and 7020 +/- 1,106, 8,727 +/- 1,188 and 9,019 +/- 1,129, respectively (P > 0.05). The mean catalase (SEM) levels in right and left testicular tissues of varicocele bearing rats,sham-operated rats, and control rats were 75.77 +/- 11.5 and 53.82 +/- 10.1, 91.94 +/- 14 and 94.90 +/- 32, 65.40 +/- 5.7 and 90.93 +/- 16.4, respectively (P > 0.05). Our results suggest that oxidative status, which reflects a relative balance between reactive oxygen species (ROS) generated and ROS scavenged, may not be responsible for the testicular dysfunction associated with experimentally induced varicocele during adolescence in rats.     

不育男性双侧Ⅰ度精索静脉曲张对睾丸体积和生殖激素水平的影响

目的 评价不育男性双侧I度精索静脉曲张对睾丸体积和生殖激素水平的影响.方法 185例不育男性双侧I度精索静脉曲张(A组)和149例正常生育男性(B组),比较其睾丸体积、卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)水平.结果 A组患者两侧睾丸体积均小于B组,但睾丸体积绝对差异和睾丸体积相对差异与B组比较,无统计学意义.A组患者血清FSH水平高于B组,而LH、T与B组相比,差异无统计学意义.结论 不育男性双侧I度精索静脉曲张可导致患者双侧睾丸体积减小,血清FSH水平升高.