[Comparison of testicular volume before and after laparoscopic varicocelectomy in children and adolescents].
Male infertility is the most frequent consequence of late diagnosis of varicocoele and not performing surgical varicocelectomy before puberty. The etiopathogenesis is still obscure. The anatomical conditions in men are conducive to the development of left varicocoele. The aim of this study is the assessment of the results of varicocelectomy on increase of testicular volume in adolescents with the grade II and III varicocoele and on improvement of potential fertility of young men.


METHODS
In the period between 1996-2004, 62 children and adolescents with varicocoele and with left small testis underwent laparoscopic varicocelectomy. Unilateral varicocelectomy was performed in 51 (83.3%) while bilateral varicocectomy was performed in 11 (17.7%) patients. The average age was 15.6 years (13-17 years). Clinical diagnosis was based on: general physical examination, andrologic and sonographic (colour Doppler) examination where testis volume and clinical degree were assessed according to Dubin and Amelar score. Laparoscopic transperitoneal procedure was carried out using two surgical techniques: testicular vein and artery ligation or only testicular vein ligation.


RESULTS
Left testis volume increase i.e. comparable volume of both testies was observed in 22 (75.9%) young men with grade II (p<0.001) and in 29 (87.9%) with grade III of clinical advancement of varicocoele (p<0.003). The increase of testis volume was noted in 43 (84.3%) patients: among 51 patients with unilateral varicocoele and in 8 (72.7%) among 11 boys operated with bilateral varicocele (p<0.001). The increase of testis volume was not significantly greater in boys who underwent spermatic artery sparing technique (p=0.85). Out of 62 patients, in 53 (85.5%) normozoospermy was observed (p<0.005).


CONCLUSIONS
Laparoscopic ligation of testicular vein produced significant increase of hypotrophic testicular volume in 82.3% operated children. The presence of hypotrophic testies in adults, after varicocelectomy before puberty is accompanied by oligoasthenoteratozoospermy and high plasma FSH, LH levels and low plasma testosterone level. Assessment of the results of the varicocelectomy in children should include in the procreation period semen analysis and the estimation of plasma FSH, LH and T levels.
Huk
Jacek
J
Katedra i Klinika Urologii, Slaska Akademia Medyczna, ul. 3 Maja 13/15, 41-800 Zabrze, Poland. drjacekhuk@poczta.onet.pl
Fryczkowski
Mieczysław
M
Kaletka
Zbigniew
Z
Szwedkowski
Maciej
M
D000293:Adolescent; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011044:Poland; D012189:Retrospective Studies; D013091:Spermatogenesis; D013737:Testis / Q000000981:diagnostic imaging* / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000601:surgery*