Testicular size following embolization therapy for paediatric left varicocele

Tasks of surgical andrology in current interdisciplinary reproductive medicine

Although the controversy about varicocele treatment options and their benefit has not been resolved, evidence is increasing that a cautious use of varicocele surgery contributes to effective management of male factor subfertility. Moreover, timely varicocele treatment might be an equally valuable prevention of later subfertility as early treatment of cryptorchidism. In reconstructive surgery of the ductal system, a more frequent use of tubulovasostomy can prevent initial failure. Furthermore, the cryopreservation of spermatic fluid for intracytoplasmic sperm injection can obviate a repeat procedure, if patency is not reached with surgery. The surgical andrologist is also the 'retriever' of sperm cells for assisted reproduction in cases of irreparable damage of the male reproductive organs. Efforts to delimit critically the indications and the results of the different techniques with large multicentre and interdisciplinary studies should be emphasized. Finally, it is encouraging that andrology does not rely solely on the successes and possibilities of assisted reproduction, but continues to inquire into the causes of male subfertility (e.g. by implementing immunohistochemical techniques into clinical 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.

Treatment of varicoceles in childhood and adolescence with Tauber's antegrade scrotal sclerotherapy

PURPOSE

The aim of this study was to evaluate surgical complications and the outcome of grade II and III varicoceles treated with Tauber's antegrade scrotal sclerotherapy.

METHODS

A total of 21 patients with a median age of 13 (range, 10 to 21) years and left-sided grade II and III varicoceles were treated with Tauber's antegrade scrotal sclerotherapy and underwent follow-up over a median period of 23 months (range, 9 to 35).

RESULTS

One grade II varicocele persisted after antegrade sclerotherapy for 6 months. After a second sclerotherapy 6 months later, no further recurrence was detected. One patient with a grade II to III varicocele had a grade I varicocele recurrence 14 months after operation. Three patients showed a slight hydrocele postoperatively.

CONCLUSION

This limited series indicates that Tauber's antegrade scrotal sclerotherapy is a safe and effective treatment for grade II and III varicoceles in children and adolescents.

A morphometric and ultrastructural study of the changes in the lamina propria in adolescents with varicocele

OBJECTIVE

To verify if changes in the lamina propria and its components, reported in adults with varicocele, are already present in adolescents with idiopathic varicocele, using a morphometric and ultrastructural study.

MATERIALS AND METHODS

Twenty testicular biopsies from adolescents (mean age 15.6 years) were obtained during surgery for left idiopathic varicocele; five testicular biopsies from adolescents (mean age 16 years) undergoing surgery for hydrocele or inguinal hernia were used as controls. Biopsy specimens were processed for light and transmission electron microscopy; the sections were evaluated morphometrically using computerized image analysis.

RESULTS

Morphometric and ultrastructural examination of the testes with varicocele showed an increased thickness in the lamina propria, caused principally by an increase in the extracellular matrix components, and deep invaginations towards the germinal epithelium.

CONCLUSION

There is detectable damage of the lamina propria in adolescents affected by left idiopathic varicocele, although not as well developed or as severe as in adults.