Introduction: Management of the adolescent varicocele focuses on optimizing fertility potential, but to date there is limited data on the success of optimizing semen parameters for individual adolescent patients following varicocelectomy. We reviewed our database of over 1600 adolescent varicocele patients to find those with both pre-and postoperative semen analyses to determine the impact of varicocele correction.
Methods: 15 Tanner stage V patients with unilateral clinically apparent left-sided varicocele (12 grade III, 3 grade II) with pre-and postoperative semen analyses were identified.
Mixed models were used to compare semen parameters pre- and post-varicocelectomy in patients with successful management. Random patient effect was used in the models to account for multiple semen analyses in patients. Model assumptions were verified.
Results: Complete elimination of the varicocele was achieved in 12/15 (80%) patients. Three patients had persistent varicocele (with down-grading in two) and declined further intervention.
For those with successful varicocele correction total motile sperm count (TMSC) improved in 100% (Figure 1), with an average increase of 44.0 (95% CI: 18.7 – 69.3) in TMSC in post-varicocelectomy analyses compared to pre-varicocelectomy (p=0.0016) . It went from abnormal ( <20mln/cc) to normal (>=20 mln/cc) in 58% (7/12). It improved but remained abnormal in 25% (3/12). In 17% (2/12) it improved within normal range. Concentration improved significantly by 20.8 million /ml on average for the post-varicocelectomy group compared to pre-procedure (p=0.0036).
For the three patients with persistent varicocele (Grades I, II and III) one had improved TMSC from abnormal to normal range and one had worsening of TMSC within normal range.
Conclusions: Successful correction of adolescent varicocele reliably improves TMSC. In over half of cases an abnormal TMSC will normalize. Incomplete correction may result in improved TMSC, which should be assessed prior to re-intervention if abnormal semen parameters represented the surgical indication. These results support intervention for adolescent varicocele associated with abnormal semen parameters.