Surgery improves testicular growth, sperm count in adolescents with varicocele

Varicocelectomy in adolescent boys with varicocele results in improved testicular growth and higher spermatogenesis measures into adulthood, suggests a study.

A group of researchers retrospectively analysed 125 patients from a registry (2011‒2022) who underwent annual follow-up until age 20 years. Those with left-sided grade II-III varicocele with persistent >20 percent of >2 mL testicular asymmetry were included.

A single surgeon performed all surgeries. Ultrasonography was used to measure testicular volumes, with catch-up growth defined as <20 percent asymmetry within 1 year. The researchers offered semen analysis after age 20 years and calculated the total motile sperm count (TMSC). They then explored the associations between surgical management and outcomes.

Catch-up growth occurred in 92 percent and 20 percent of surgical and conservatively managed patients, respectively (p<0.01). The left and total testicular volumes were higher in the surgical group (17.9 and 36.0 mL, respectively) than in the nonsurgical group (15.8 and 32.3 mL; p<0.001) at age 20 years.

Eighty-two participants consented to semen analyses, which revealed higher TMSC among patients who underwent surgery (5,914.8 x 10⁶ vs 2,124.5 x 10⁶; p<0.001).

Earlier surgery (elementary or junior high school) correlated with higher adult testicular volume and TMSC relative to high school intervention. Furthermore, eight patients (8 percent) did not show catch-up growth, and two had Klinefelter syndrome.

“These findings highlight associations between timing of surgery and outcomes, supporting further investigation to inform optimal surgical indications,” the researchers said.

“Varicocele occurs in up to 20 percent of adolescent boys and is associated with impaired testicular growth and potential infertility,” they said.