Does varicocelectomy improve semen analysis outcomes in adolescents without testicular asymmetry?. Issue 1 (February 2017)

• Record Type: Journal Article
• Authors: Chu, David I.; Zderic, Stephen A.; Shukla, Aseem R.; Srinivasan, Arun K.; Tasian, Gregory E.; Weiss, Dana A.; Long, Christopher J.; Canning, Douglas A.; Kolon, Thomas F.
• Is Part Of: Journal of pediatric urology. Volume 13:Issue 1(2017)
• Page Start: 76.e1
• Page End: 76.e5
• Publication Date: 2017-02
• Subjects: Adolescent varicocele -- Semen analysis -- Total motile count -- Varicocelectomy; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2016.09.010
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Purpose: The main indications for adolescent varicocelectomy are testicular hypotrophy or pain. However, we have previously shown that both serial total testicular volume and volume differential are weakly associated with semen quality. The ultimate patient goal is paternity, but semen analysis is critical to appropriate management of varicocele. We hypothesize that varicocelectomy improves total motile count (TMC) among patients who only have abnormal semen analysis (SA) parameters, but not among those with potential hormonal dysfunction such as Klinefelter syndrome or cryptorchidism. Methods: We retrospectively reviewed our registry of adolescent males followed with a clinical left varicocele. For this study, subjects without sustained testicular asymmetry, who were Tanner V, and gave at least one preoperative SA were included. Subjects were excluded if they had embolization for their varicocele or no postoperative SA. Primary outcome was change in TMC before and after surgery, compared using the Wilcoxon signed rank test after stratifying by surgical indication. Secondary outcomes included rates of improved TMC and normalized TMC (>20 million) after surgery, compared across covariates using the Fisher exact test. Results: Seventeen patients met the eligibility criteria, 11 of whom underwent repair for only abnormal preoperative TMC. Overall, median age (interquartile range [IQR]) at first preoperative SA was 17.6 (15.9–17.9) years. The median preoperative TMC across all SA was 2.8 (0.7–7.4) million. The median age at surgery was 18.2 (16.8–18.9) years. Postoperatively, the median TMC across all SA increased to 18.2 (3.6–18.2) million (Wilcoxon signed rank test, p < 0.01; see Figure). The improvement in TMC occurred primarily in the group who only had abnormal preoperative TMC (82% improved, 55% normalized); lack of improvement was seen in patients who had a history of Klinefelter or orchiopexy for cryptorchidism. Conclusions: Adolescent varicocele patients should undergo SA after development of Tanner V. Varicocelectomy has a high success rate for improving TMC in adolescent or young adult males who only have abnormal TMC and no history of cryptorchidism. Figure Change in total motile count after varicocelectomy by patient.