Paediatric varicocele – indications for early surgical repair: a prospective study
Purpose Indications for paediatric varicocelectomy remain controversial. A project has been designed to determine indication criteria related to testicular hypoplasia, varicocele grade and pubertal stage. Supported by grants IGA MZCR No 6983-4, 8817-4. Material and methods Between 1997-2004, 166 patients with varicocele grade II.-III. , 8.1 to 17.4 14.6) of age, were prospectively assigned into three research groups. Oy (Patients without significant testicular asymmetry (atrophy index AI O25 %, 29.4) or bilateral varicocele were assigned to surgery - Group 3 (52) or assigned (retrospectively) to conservative group – Group 4 (18) if the planned surgery was not performed. Laparoscopic varicocelectomy was performed with lymphatic sparing (LS) or without (LNS). Mean follow-up: 3.6 y (range 1 to 8). Results No differences in hormonal and sperm parameters were found between the groups 1 and 2. After the LS repair in the group 1, higher fast progressive motility (45.0 % versus 29.2 %; p = 0.02722) and better sperm morphology (57.0 % versus 45.4; p = 0.01549) were achieved in comparison with LNS repair. Higher sperm concentrations (73.8 versus 43.5 mil/mL; p = 0.02081) and higher fast progressive motility (38.3 versus 28.0 %; p = 0.02885) were found in the group 3 as against the group 4. After the LS repair in the group 3, higher stimulation LH levels (17.7 versus 9.1 IU; p = 0,03455) were detected in varicocele grade III (versus grade II), better sperm morphology was found in patients operated during pubertal stage I-III in comparison with the pubertal stage IV-V (58.0 versus 49.8 %; p = 0,01658). Conclusions A paediatric varicocele with asymmetrical testes (especially grade III) is already a serious and progressive disease during adolescence and is an indication for early lymphatic-sparing repair; in symmetrical testes observation until reliable sperm analysis is possible is appropriate.