Fertility After Early Varicocele Treatment Still Unknown

By Reuters Staff

October 25, 2018

NEW YORK (Reuters Health) - There is moderate evidence that treating varicocele in children and adolescents increases testicular volume and sperm concentration, but long-term outcomes remain unclear, according to a new systematic review and meta-analysis.

"At this moment, we are not able to recommend any surgical/ interventional technique as the standard treatment of varicocele," Dr. Mesrur Selcuk Silay of Istanbul Medeniyet University in Turkey and colleagues note in in European Urology, online October 10. "Lymphatic preservation is highly recommended in order to decrease the rates of hydrocele."

Varicocele occurs in 14% to 20% of adolescent males, and has been thought to affect future fertility, Dr. Silay and his team write. Treating varicocele appears to improve sperm parameters and result in "testicular catch-up growth," they add, but long-term outcomes such as fertility and paternity have not been studied.

The authors analyzed 98 studies of 16,130 patients in total, including 12 randomized controlled trials (RCTs), 47 non-randomized comparative studies and 39 case series.

Treatment success rates were above 85% in all studies. Eight RCTs reported testicular volume changes and catch-up growth, and found a mean increase of 1.52 ml with treatment compared to observation.

Two RCTs recorded sperm quality parameters before and after treatment and in untreated controls. Sperm concentration increased by 25.5 million/ml with treatment compared to observation, but sperm motility and morphology were similar in the treated and untreated groups.

Treatment success appeared to be similar for open surgery and laparoscopic methods, Dr. Silay and his team found, while hydrocele formation was significantly less likely with lymphatic-sparing surgery compared to non-sparing surgery. But the data did not allow for comparing the effectiveness of different treatments.

The two studies recording data on paternity were biased, with conflicting outcomes.

"We could not identify an ideal candidate for varicocele treatment according to the available literature," Dr. Silay and his team write. "However, adolescents with high-grade varicocele, hypotrophic left testicle, pain, and poor sperm parameters would be more likely to benefit from varicocele treatment."

Dr. Silay was not available for an interview by press time.

SOURCE: https://bit.ly/2ApgY4f

Eur Urol 2018.

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