Ces Urol 2000, 4(1):27-31 | DOI: 10.48095/cccu2000005

Clinical and hormonal findings in children and adolescents with varicocele

R. Kočvara^1,3, K. Novák¹, J. Doležal², J. Kříž¹, V. Kubíček¹, Z. Staněk², R. Hampl⁴

¹ Urologická klinika Všeobecné fakultní nemocnice, Praha 2

² Urologické oddělení Nemocnice České Budějovice

³ Subkatedra dětské urologie IPVZ Praha

⁴ Endokrinologický ústav

Objectives: Indications for varicocele repair in children and adolescents remain controversial. A prospective multicenter study started in 1996. Preliminary data relating to clinical and hormonal findings in patients with varicocele are presented to challenge the present criteria for an early operation.

Methods: 146 children and adolescents, aged 7-17 years, have been involved in the study since 1996. Clinical assessment of the varicocele, grade and pubertal stage, ultra-sonographic study, determination of basal and stimulation hormonal levels were performed.

Results: A hypoplastic testis was found in 36% of patients with a grade II.-III. varicocele and in 12% of patients with a grade I. varicocele The testicular atrophy index varied from 28 to 37% according to pubertal stages (P1-P5). Prepubertal boys (P1) with testicular hypoplasia are significantly older than boys with symmetrical testes (p<0.05), in other pubertal stages the difference could not be detected. A hyperreaction of LH and/or FSH to gonadorelin stimulation was found in 98 /62% of the boys without significant association with testicular hypoplasia. The LH hyperreaction was found in 47% of the P1-P3 and only in 15% of the P4-5 pubertal stage patients. The FSH hyperreaction was encountered in only 16% of prepubertal (P1) boys with varicocele, as compared to 47% of patients after the onset of the puberty. According to present criteria (testicular hypoplasia, hormonal hyperreaction, bilateral varicocele) , 104 (71%) patients with varicocele would be indicated for an early operation, which contradicts to the estimated number of patients infertility associated with varicocele.

Conclusions: The preliminary data in our study point to the importance of the pubertal period in the development of pathological testicular changes in varicocele patients. An excessive number of young boys seem to be indicated for surgery according to the present criteria. The significance of these criteria for the fertility remains to be elucidated in the course of the study.

Keywords: Varicocele, GnRH stimulation test, Varicocele in children and adolescents

Published: January 1, 2000