Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents.

PURPOSE: Surgical indications for correcting adolescent varicocele include high varicocele grade and testicular hypotrophy. To our knowledge these findings have not been correlated with semen parameters to date. We examined the relationship between unilateral left varicocele grade or the testicular volume differential and semen parameters in adolescents.

MATERIALS AND METHODS: Semen analyses were done in 57 Tanner stage V adolescent males at ages 14 to 20 years (mean+/-SD 18 +/- 1.6). Varicocele grade was determined by the attending urologist. Testicular volumes were determined by scrotal ultrasound performed by an attending sonologist. Data analysis was performed using nonparametric statistical methods.

RESULTS: Boys with testicular volume differentials greater than 10% vs those with differentials less than 10% had significantly lower sperm concentration and total motile sperm counts. For differentials greater than 20% these decreases were more dramatic. Percent motile sperm was significantly lower for boys with volume differentials greater than 20% vs those in the less than 10% and 10% to 20% categories. No significant differences were detected in percent normal morphology among the volume differentials. No significant differences were detected for any semen analysis parameter as a function of varicocele grade.

CONCLUSIONS: Sonographically derived volume differentials greater than 10% between normal and affected testes correlate with a significantly decreased sperm concentration and total motile sperm count. This finding may serve as a marker to identify adolescents with unilateral left varicocele who are at greatest risk for future infertility. At least semen analysis and close annual followup of these adolescents seem warranted.