Pediatric varicocele treatment: fertility outcomes are unclear

  • Eur Urol
  • 10 Oct 2018

  • curated by Craig Hicks
  • Clinical Essentials
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Takeaway

  • Pediatric varicocele treatment improves testicular volume and sperm concentration, but effects on paternity and fertility outcomes are unclear.

Why this matters

  • “Varicocele in children and adolescents is one of the most controversial topics in pediatric urology and has an incidence of up to 14%-20% in adolescent boys, similar to adults,” say researchers.

Study design

  • Researchers conducted a systematic review and meta-analysis of 12 randomized controlled trials (RCTs), 47 nonrandomized comparative studies, and 39 single-arm case studies of pediatric varicocele treatment (n=16,130).
  • Funding: European Association of Urology.

Key results

  • Success rates were >85% among all studies.
  • Treatment improved testicular volume (mean difference, 1.52; 95% CI, 0.73-2.31 mL) and increased total sperm concentration (mean difference, 25.54; 95% CI, 12.84-38.25 million/mL).
  • Lymphatic sparing surgery was associated with a significant decrease in hydrocele formation (P=.02).

Limitations

  • Findings were limited by data heterogeneity and lack of long-term follow-up demonstrating paternity and fertility outcomes.

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