Histological findings in testes with varicocele during childhood and their therapeutic consequences

Abstract

Contrary to widespread opinion, varicocele is a common disorder in children and can be seen in 10-year-old boys. The peak incidence of varicocele is reached at 15 years. Usually the disorder remains asymptomatic and is overlooked. Over 5 years we observed 22 boys with varicocele. Testicular biopsy carried out in 10 of them demonstrated essentially the same changes of tubules, interstitium and blood vessels seen in adults, though in a less severe form. Surgical removal of varicocele should therefore be carried out during childhood as soon after diagnosis as possible, regardless of degree of severity and the presence or absence of symptoms. This averts the danger of progressive and irreversible damage to the testes. The argument that infertility does not necessarily result in each case of varicocele is probably not relevant due to the uncertainty involved in an individual case. The high risk of later infertility should be compared with the low risk of surgery during childhood.

Improvement of Sexual Activity, Pregnancy Rate, and Low Plasma Testosterone After Bilateral Varicocelectomy in Impotence and Male Infertility Patients

“…This improvement in low level of LH is consistent with the impairment of Leydig cell ultrastructure observed in testicular biopsy samples in some patients with a varicocele, and Leydig cell function in rats with experimental varicoceles [19].…”

“…Patients with varicocele have altered levels of serum inhibin, which is produced by Sertoli cells [32]. In addition, histologic studies of testicular biopsies from patients with varicoceles have demonstrated that germ cells in the adluminal compartment of the seminiferous tubules are sloughed off, a sign often associated with compromised Sertoli cell function [12,19]. These studies suggest that insufficient endocrine support of Sertoli cell function may compromise spermatogenesis in the varicocele testis.…”

Pituitary and Testicular Function in Adolescents With Varicocele

“…Reduction in the volume of the ipsilateral testicle [16,22] as well as histological alterations similar to those observed in the adult male with varicocele have been reported in boys with varicocele [6,7]; therefore, early surgery for varicocele has been recommended to prevent further alterations of the testicular functions [2,10,11].…”

Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes

“…37 In humans, the presence of a varicocele leads to elevated temperature of the testicle and impaired spermatogenesis. 38,39 Hypoxia In rats, the expression of hypoxia inducible factor is elevated in the presence of a varicocele and subsequently decreases with repair. 40,41 It is postulated that stasis of blood could affect partial oxygen pressure and metabolism in the testis.…”