Controversies in the evolution of paediatric-adolescent varicocele: clinical, biochemical and histological studies.
OBJECTIVE
To study hormonal and histological parameters of paediatric-adolescent varicocele in order to know certain aspects of its natural history, in an attempt to find prognostic markers of testicular damage.


METHODS
In a prospective cross-sectional study, we evaluated 93 children and adolescents with left unilateral varicocele and 29 healthy males as control group. All of them were classified according to Tanner stage. Scrotal Doppler in both testes and GnRH and human chorionic gonadotrophin (hCG) tests were performed in all subjects. Surgery was performed in 28 patients and homolateral testicular biopsy in 18.


RESULTS
Hormonal measurements of patients with varicocele were compared with a control group for each Tanner stage. Testicular biopsy specimens were analysed by light and electron microscopy. We only observed statistical differences in Tanner III patients in basal FSH (median and range) controls=1.70 (1.10-3.70) IU/l vs varicocele=4.20 (1.00-7.50) IU/l, P<0.05 and in Tanner IV patients in LH post-GnRH: controls=11.0 (7.50-15.0) IU/l vs varicocele=18.0 (5.10-29.0) IU/l, P<0.05 and in testosterone post-hCG: controls=9.50 (7.7-10.0) ng/ml vs varicocele=12.0 (6.2-23.0) ng/ml, P<0.01. No correlation was found between the various clinical grades of varicocele and hormonal measurements for each Tanner stage. No statistically significant differences were found between pre- and post-operative hormonal findings, either in basal levels or in maximal responses. On the other hand, no morphological abnormalities were observed by electron microscopy in germ cells, tubular wall and interstice.


CONCLUSIONS
There appears to be no reliable biochemical marker in children and adolescents that may predict impaired testicular function. A significant size discrepancy between both testes, testicular pain and a hyperresponse to GnRH stimulation should continue to be, for the time being, the indications for surgery.
Fideleff
H L
HL
Endocrinology Unit, Department of Medicine, Hospital T Alvarez, Frances, Buenos Aires, Argentina. lfideleff@intramed.net.ar
Boquete
H R
HR
Suárez
M G
MG
Ruibal
G F
GF
Sobrado
P G
PG
Azaretsky
M
M
Pujol
A B
AB
Sequera
A M
AM
Giuseppucci
J
J
Ponzio
R
R
D000293:Adolescent; D001706:Biopsy; D002648:Child; D006063:Chorionic Gonadotropin; D005640:Follicle Stimulating Hormone / Q000097:blood*; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D007985:Leydig Cells / Q000473:pathology; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D012016:Reference Values; D012708:Sertoli Cells / Q000473:pathology; D013087:Spermatids / Q000473:pathology; D013091:Spermatogenesis; D013737:Testis / Q000473:pathology; D013739:Testosterone / Q000097:blood; D014646:Varicocele / Q000097:blood* / Q000473:pathology / Q000503:physiopathology*
D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone