When to treat varicocele?

In order to find criteria that might prognosticate the outcome of varicocele treatment, we studied 48 patients with unilateral or bilateral varicocele. Examinations prior to therapy included GnRH test and determination of alpha-glucosidase in addition to normal sperm analysis. The morphological analysis was performed according to the Düsseldorf classification. Thirty-five of the 48 patients underwent varicocele sclerosing, 13 patients received no therapy. Ten normozoospermic donors served as control. At 6-7 months after sclerosing, the aforementioned parameters were checked in all patients. Almost all of the untreated patients had pathological GnRH tests initially and on control, and sperm parameters had deteriorated. In the treated group, 75% had pathological GnRH tests initially. Of these, 70% improved, particularly sperm morphology with reduction of hyperelongated forms, and 30% had GnRH tests returned to normal. However, improved sperm parameters were also observed in 75% of patients who had normal GnRH tests initially. The improvement of sperm parameters was not associated with significant changes in alpha-glucosidase (normal initial values). According to these results, the GnRH test does not seem to be an important prognostic parameter for the outcome of varicocele therapy. However, patients with pathological values should be treated. Determination of alpha-glucosidase as an epididymal marker is no decisive criterion either. The most significant improvement was observed in patients with increased occurrence of hyperelongated spermatozoa.