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Abstract Study question What is the clinical presentation of adolescent varicocele and the impact of its repair on semen quality? Summary answer Adolescent varicocele usually presents as testicular pain and does not influence semen quality. Varicocele ligation does not impact postoperative semen results in this patient population. What is known already Varicocele is a common condition characterized by the abnormal dilation of the pampiniform plexus of veins resulting in testicular dysfunction and impaired semen quality. While the effect of varicocelectomy on the fertility potential of adult men has been commonly explored, its impact on semen parameters of adolescents is less commonly investigated. Study design, size, duration The charts of 2171 patients who underwent microsurgical subinguinal varicocelectomy for clinically palpable disease between 2011-2023 were retrospectively reviewed. Patients 19 years of age were included in the analysis. Participants/materials, setting, methods The patients’ medical charts were reviewed to include demographic and clinical characteristics; indication of surgery, body mass index, testis size, grade of clinical disease, vein diameter (assessed with scrotal ultrasound) and semen analysis results (WHO 2010). Data were analyzed using Wilcoxon Signed Ranked. Mean ± SD and median (IQR) were used to report normally and non-normally distributed data, respectively. A p value 0.05 was considered significant. Main results and the role of chance A total of 94 adolescent patients were included in the study. Their mean BMI was 22.14±5 Kg/m2, mean left testis size was 12.26 ± 3.05 cm3 and right testis size 13.26±3.94 cm3. The maximum vein diameter 4.7±1.04 mm and right vein diameter 2.21±0.83 mm. 83 patients underwent unilateral Microsurgical Varicocelectomy while 5 patients underwent bilateral Microsurgical Varicocelectomy. Left varicocele was of grades 3, 2 and 1 in 65, 18 and 11 patients, respectively. Surgery was indicated for testis size discrepancy in 36.2% of cases and on elective basis (prior to army recruitment) in 63.8% of cases. Table 1 presents the pre- and post-operative semen parameter results. Patients had normal pre-operative medians of sperm count, total motility and normal morphology. No significant post-operative changes were observed in the semen quality of adolescents. Limitations, reasons for caution Results were obtained from a relatively small sample size. However, varicocele is less commonly performed on adolescents necessitating further studies on this patient population. Wider implications of the findings Results of this study shed the light on the characteristics of adolescents presenting with varicocele. Trial registration number NA
Majzoub et al. (Mon,) studied this question.