Testicular and vascular changes in children and adults with varicocele

We analyzed bilateral testicular biopsies of 188 infertile patients with idiopathic left varicocele. The left side had significant pathological tubular testicular changes compared to the right side, whereas in only 7 per cent of the patients tubular damage was more pronounced on the right side. The Leydig cell pathological score was identical in both testes in 95 per cent of the patients. However, the lower the Leydig cell pathological score the better the testicular histology, suggesting an association between Leydig cell score and testicular function. Of the 188 patients 11 boys and 8 adults were randomly selected, and they displayed clear endothelial proliferative lesions of the capillaries at the ultrastructural level. Proliferative endothelial lesions in the patients with varicocele preceded the testicular changes. This, together with the prevalence of tubular damage at the site of the varicocele and the reversibility of these changes postoperatively, emphasizes the deleterious effects of varicocele as a cause of infertility in these patients. Early surgery for boys in whom the first signs of testicular atrophy occur is highly recommended.