The adolescent varicocele: The crucial role of hormonal tests in selecting patients with testicular dysfunction

Abstract

Background/Purpose: Early identification and treatment of varicocele during adolescence may reduce the risk of infertility. Prophylactic surgery on all adolescents with varicocele would be unnecessary surgery on a high percentage of them. Suggested guidelines for early intervention have included testicular volume loss and abnormality in the hormonal integrity of the hypothalamic-pituitary-testicular axes. Previous studies have documented no correlation between testicular volume loss and abnormal response to GnRH test. The role of these 2 prognostic factors in predicting semen abnormalities in this age group never has been investigated, so far. In the current study we correlated hormonal tests and orchidometry to semen analysis in a selected group of adolescents. Methods: Adolescents with varicocele and Tanner stage V underwent semen analysis, Prader orchidometry, and hormonal tests (basal LH and FSH [bLH and bFSH], testosterone [T], LH and FSH after GnRH stimulation test [sLH and sFSH]). According to semen analysis (in relation to Oval Motility Index) patients were divided into 2 groups: group A, adolescents with pathologic semen and group B, adolescents with normal semen. Hormonal tests and testicular volumes (in those with left unilateral varicocele) were compared between the 2 groups. Statistical analysis was performed using Mann-Whitney U test and Student's t test. Results: Of 76 patients, 20 (Group A) had a pathologic semen analysis. Levels of bLH, bFSH, sFSH were significantly higher in group A compared with group B (56 with normal semen). sLH was higher in group A, but the difference was not statistically significant. T levels were not different between the 2 groups. Of 68 patients who had left unilateral varicocele and no previous inguinal—scrotal surgery 14 had pathologic semen analysis. There was no statistically significant difference between the 2 groups for any of the orchidometric parameters investigated. Conclusions: The evaluation of testicular volumes during physical examination for varicocele in Tanner stage V adolescents is not predictive for testicular dysfunction. LH and FSH dosages with or without GnRH stimulation test can identify those subjects at risk for infertility, and their use should be encouraged for selecting patients who need surgical correction. J Pediatr Surg 38:120-123. Copyright 2003, Elsevier Science (USA). All rights reserved.