Semen analysis in patients treated for varicocele in pediatric age: are surgical outcomes enough to preserve the fertility potential?

Preserving the fertility potential of adolescent patients with varicocele is still the main outcome of pediatric and adolescent urologysts; the aim of this study is to assess the fertility potential of patients treated for varicocele with testicular hypotrophy in absence of post-operative complications, with complete ipsilateral testicular catch-up growth and normal hormonal values.

METHODS: The Authors collected data from adolescents with varicocele aged between 10 and 16 years treated at their Institution between September 2010 and September 2015. Inclusion and exclusion criteria were created; all patients were followed clinically and with hormonal tests before and after surgery and then re-evaluated after semen analysis. Semen quality was correlated with hormonal status, surgical complications and testicular volume.

RESULTS: 133 subjects without recurrences and with testicular catch-up growth were enrolled; at surgery 52 patients had grade III varicocele, 80 had grade II varicocele and 1 patient had grade I varicocele. Surgical complications at 18 months were 6 hydroceles (2 in grade III and 4 in grade II varicocele). Semen analysis was performed on 41 patients: 75% had a good semen quality, 9.7% fairly good semen quality and 14.6% poor semen quality. Considering grade III patients (12 subjects), 7 (58%) had good quality, 3 (25%) fairly good quality and the remaining 2 (16.6%) poor semen quality. In grade II patients, 23 (79.3%) had good quality, 4 (13.7%) fairly good quality and 2 (6.8%) had poor quality (P>0.05). There was no correlation between semen quality, hormonal status and pre-operative grade of varicocele and post-operative testicular volume.

CONCLUSIONS: The results demonstrate that varicocelectomy alone in well-studied and fully treated pediatric patients does not wholly preserve their fertility potential.