Controversies in the evolution of paediatric-adolescent varicocele: clinical, biochemical and histological studies

Objective: To study hormonal and histological parameters of paediatric-adol escent varicocele in order to know certain aspects of its natural history, in an attempt to find prognostic markers of testicular damage. Design and Methods: In a prospective cross-sectional study, we evaluated 93 children and adolescents with left unilateral varicocele and 29 healthy ma les as control group. All of them were classified according to Tanner stage . Scrotal Doppler in both testes and GnRH and human chorionic gonadotrophin (hCG) tests were performed in all subjects. Surgery was performed in 28 pa tients and homolateral testicular biopsy in 18, Results: Hormonal measurements of patients with varicocele were compared wi th a control group for each Tanner stage. Testicular biopsy specimens were analysed by light and electron microscopy. We only observed statistical dif ferences in Tanner III patients in basal FSH (median and range) controls = 1.70 (1.10-3.70) IU/l vs varicocele = 4.20 (1.00-7.50) IU/l, P < 0.05 and i n Tanner IV patients in LII post-GnRH: controls = 11.0 (7.50-15.0) IU/l vs varicocele = 18.0 (5.10-29.0) IU/l, P < 0.05 and in testosterone post-hCG: controls = 9.50 (7.7-10.0) ng/ml vs varicocele = 12.0 (6.2-23.0) ng/ml, P < 0.01. No correlation was found between the various clinical grades of vari cocele and hormonal measurements for each Tanner stage. No statistically si gnificant differences were found between pre- and post-operative hormonal f indings, either in basal levels or in maximal responses. On the other hand, no morphological abnormalities were observed by electron microscopy in ger m cells, tubular wall and interstice. Conclusions: There appears to be no reliable biochemical marker in children and adolescents that map predict impaired testicular function. A significa nt size discrepancy between both testes, testicular pain and a hyperrespons e to GnRH stimulation should continue to be, for the time being, the indica tions for surgery.