Relationship between varicocele grade, vein reflux and testicular growth arrest

Abstract

The development of testicular hypotrophy (or testicular growth arrest) in pediatric patients with varicocele is the first indication for surgery. The aim of this study is to identify the correlation between grade of varicocele, grade of vein reflux and testicular growth arrest. Between 2000 and 2001, we recruited 226 patients affected by varicocele without testicular hypotrophy and with grades 2-3 spermatic vein reflux observed during Doppler velocimetry. Medical examinations carried out every 6 months allowed the assessment of varicocele grade, testicular volume, and grade of vein reflux. Other parameters considered in the study were: mean time of grade deterioration, mean time to onset of testicular growth arrest and the relationship between varicocele grade and testicular growth arrest. Deterioration of the condition was experienced in 92 patients (40%) in which 60 patients showed higher varicocele grades without testicular growth arrest, while 32 patients developed testicular growth arrest. There was a statistically significant relationship between testicular growth arrest and varicocele grades (grade 2 and 3) and between grade of reflux and testicular growth arrest. Although it is not possible to determine which patients will develop testicular growth arrest, the assessment of vein reflux allows the identification of those subjects who may potentially develop such a condition.

Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: A population based study

“…Left testicular volume tended to be smaller than right testicular volume in boys with higher grade left varicoceles, and the proportion of boys with testicular size discrepancies increased with the severity of the varicocele. This result is consistent with previous studies that reported that a volume discrepancy between the testes became clinically apparent in adolescents with a varicocele, implying significant negative effects of the varicocele on testicular growth, especially during the rapid growth of the testis 10,11 . Most of the testis comprises seminiferous tubules, thus a decrease in testicular volume can be interpreted as a decrease in sperm quality, though there is some disagreement about the correlation between testicular volume decreases and sperm impairment 12,13 .…”

“…This result is consistent with previous studies that reported that a volume discrepancy between the testes became clinically apparent in adolescents with a varicocele, implying significant negative effects of the varicocele on testicular growth, especially during the rapid growth of the testis. 10,11 Most of the testis comprises seminiferous tubules, thus a decrease in testicular volume can be interpreted as a decrease in sperm quality, though there is some disagreement about the correlation between testicular volume decreases and sperm impairment. 12,13 From the perspective of fertility preservation, the longer the period in which the testis is exposed to a varicocele, the more serious the sperm impairment is likely to be.…”

Significant worsening sperm parameters are associated to testicular hypotrophy in patients with a high grade varicocele

“…12 However, in a study by Zampieri et al, 465 patients were divided into two groups; one consisting of the laparoscopic arterypreserving varicocelectomy patients (group 1) and the other comprising patients receiving open inguinal microscopic artery-preserving varicocelectomy with a venous---venous bypass (group 2). The risk for testicular growth arrest is time dependent and related to the varicocele and reflux grade.…”

Los parámetros espermáticos significativos que empeoran están asociados con la hipotrofia testicular en pacientes con varicocele de alto grado

“…El riesgo de detención del crecimiento testicular depende del tiempo y está relacionado con el grado de varicocele y reflujo 12 . Sin embargo, en un estudio realizado por Zampieri et al, 465 pacientes fueron divididos en 2 grupos; uno estuvo formado por los pacientes de varicocelectomía laparoscópica con preservación arterial (grupo 1) y el otro por los pacientes que reciben varicocelectomía microscópica inguinal abierta con preservación arterial con un bypass venoso (grupo 2) 13 .…”