The chance for fertility in adolescent boys after corrective surgery for varicocele

We estimated the efficacy of a surgical procedure in adolescent patients with varicocele and left testicular atrophy. A total of 25 young men (mean age 23.6 years) had a complete andrological followup for 10 years after successful ligation of the spermatic vein (according to Ivanissevich) to correct left varicocele and testicular atrophy. Levels of follicle-stimulating hormone, luteinizing hormone and testosterone in the plasma were normal in all cases. Patients were characterized into 2 distinct groups: group A--11 patients with asthenoteratospermia and group B--14 with a normal spermiogram. There was a significant difference between groups A and B in the number of sperm per ejaculate (32 x 10(6) in A and 234.9 x 10(6) in B, p < 0.001). Preoperatively there was no difference between these 2 groups regarding testicular atrophy of the left compared to the right testis (87% in A and 86.4% in B) and the comparative testicular histology of biopsies since the number of Ad spermatogonia per tubule was considerably reduced in all patients (right side 0.68 +/- 0.71 and left side 0.38 +/- 0.39 in A, and right side 0.15 +/- 0.17 and left side 0.14 +/- 0.11 in B). In both groups there was no distinguishable difference in the degree of atrophy of seminiferous tubules or Leydig cells in both testes, or patient age at surgery (mean 13.3 years in A and 12.8 years in B). While the left testis of patients in group B caught up in size to the contralateral testis, the left testicular volume in patients in group A was only 80% of the right testicular volume (p < 0.03, the Fisher test). One patient from group B required a second surgical procedure because of a relapse. Persistent atrophy of the left testis in group A indicates that some patients benefit suboptimally from the conventional surgical procedure.