Update on the novel management and future paternity situation in adolescents with varicocele

Abstract

Varicocele is a progressive disease, and the incidence of varicocele and varicocele related testicular hypotrophy increases with puberty. This review updates novel management and future paternity potential in adolescents with varicocele. Main goal of treatment of the adolescent varicoceles is preservation of fertility. Current recommendations for adolescent varicocele repair are testicular hypotrophy (>2 mL or >20%) on the affected side and/or impaired spermatogenesis in the post-pubertal period. The best treatment modality for adolescent varicocele should include elimination of the varicocele with lower complication rates. Microsurgical varicocelectomy techniques have been shown to result in fewer recurrences and postoperative complications than conventional varicocelectomy in adolescents. We conducted a meta-analysis, including 2 studies with the control groups, and reporting paternity situation after varicocele treatment. In this metaanalysis, varicocele repair increases paternity rate 2.42 times with a p value of 0.000. Adolescents with varicocele and their families should be counselled in the light of these findings.

Systematic review of treatment methods for recurrent varicoceles to compare post‐treatment sperm parameters, pregnancy and complication rates

“…Primary varicoceles in adults and adolescents have been treated with open surgical via macroscopic or microscopic approach, laparoscopic and radiologic intervention via embolisation or sclerotherapy (Çayan & Akbay, ; Çayan et al, , ; Rotker & Sigman, ). Our previous meta‐analysis, consisting of 36 studies, has reported overall spontaneous pregnancy rate as 37.7% with the high inguinal technique, 42% with the microsurgical varicocelectomy, 30% with the laparoscopic varicocelectomy, 33.2% with the radiologic embolisation and 36% with the macroscopic inguinal varicocelectomy for the treatment of primary varicocele in infertile men (Çayan et al, ).…”

“…Recurrence of varicocele may be seen in 0 to 45% of men who underwent primary repair, depending on the original treatment approach (Çayan et al, , ; Rotker & Sigman, ). Recurrence and hydroceles have been reported with higher incidence after repair of paediatric varicoceles (Çayan et al, ; Nees & Glassberg, ). Rotker and Sigman () reviewed varicocele recurrence as an outcome after the treatment, and they reported up to 35% of recurrence, depending on the primary technique.…”

“…Although treatment of varicocele may provide improvement in semen parameters in adults and testicular catch up in adolescents, some males with varicocele might not have benefit from the treatment due to varicocele recurrence, hormonal dysfunction, genetic and molecular abnormalities or unexplained reasons (Çayan & Akbay, ; Çayan, Bozlu, & Akbay, ; Çayan et al, ). The incidence of recurrent varicocele after primary treatment ranges from 0% to 45% based on different treatment techniques (Çayan & Akbay, ; Çayan et al, ; Çayan, Shavakhabov, & Kadioglu, ; Rotker & Sigman, ). Therefore, a method for the treatment of varicocele should provide no or low recurrence rate.…”

Resveratrol benefits on sperm DNA, chromatin structure and reproductive outcomes of varicocelized rats

“…Varicocele is the most common cause of infertility in the world with high incidence among adults and adolescents (Agarwal et al, 2012; Shefi & Turek, 2006). Epidemiological studies have shown that the onset of varicocele coincides with the onset of puberty (Akbay et al, 2000; Alsaikhan et al, 2016) and also it has a progressive deleterious effect on fertility (Çayan et al, 2017). In fact, due to the high prevalence of varicocele in adolescents, more attention should be directed to this population aiming an early therapy in order to avoid irreparable consequences on the fertility (Abbasi et al, 2007).…”