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S18-10
(P)
DOES VARICOCELECTOMY IMPROVE ADOLESCENT SEMEN PARAMETERS?
Thomas KOLON, Stephen ZDERIC, Aseem SHUKLA, Arun SRINIVASAN, Gregory TASIAN, Dana WEISS, Christopher
LONG and Douglas CANNING
Childrens Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA
PURPOSE
The main indication for adolescent varicocelectomy has been left testicular hypotrophy. However, we have previously
shown that both total testicular volume and volume differential have a small to moderate predictive ability for semen
quality. While the ultimate patient goal is paternity, semen analysis is critical to appropriate management of these
patients. We examine the success of varicocele repair and hypothesize that varicocelectomy will significantly improve
adolescent semen parameters.
MATERIAL AND METHODS
We prospectively followed adolescent males with a clinical left varicocele. Each patient had bilateral testicular volume
measurement through puberty. For patients without pain or sustained volume differential (>20%), a semen analysis
(SA) measuring total motile count (TMC) was obtained after Tanner 5 development. Those with at least two abnormal
semen analyses three months apart (TMC
RESULTS
20 consecutive Tanner 5 patients underwent surgery. Six subjects were excluded (refused post-op SA-5,
cryptorchidism-1) for a final cohort of 14. Mean age (years) at diagnosis was 12.7 (9-17) and at surgery was 16.2 (15-
19). Mean pre-op TMC= 3.6 million (0-16.9) and mean post-op TMC= 24.2 million (0.23-84.4). 11/14 patients (78.6%)
showed significant improvement in TMC with seven patients moving into the normal range (p=0.01, paired t-test).
CONCLUSIONS
Adolescent varicocele patients should undergo semen analysis after Tanner 5 development. Varicocelectomy has a high
success rate for improving semen parameters in adversely affected youths.