Long-Term Outcomes of Varicocelectomy in Children and Adolescents: Impact of Timing on Testicular Growth and Spermatogenesis.

Abstract

Varicocele occurs in up to 20% of adolescent boys and is associated with impaired testicular growth and potential infertility. Although surgical indications based on testicular asymmetry are established, the optimal age for intervention remains unclear. This study evaluated the long-term associations between varicocelectomy and testicular growth and semen parameters in children/adolescents, with special attention to preadolescent patients. We retrospectively analyzed 125 patients from a registry (2011-2022) who underwent annual follow-up until age 20. Inclusion required left-sided grade II-III varicocele with persistent > 20% or > 2 mL testicular asymmetry. All surgeries were performed microsurgically by a single surgeon. Testicular volumes were measured ultrasonographically; catch-up growth was defined as < 20% asymmetry within 1 year. After age 20, semen analysis was offered, and total motile sperm count (TMSC) was calculated. Associations between surgical management and outcomes were assessed. Catch-up growth occurred in 92% of surgical patients vs 20% in conservatively managed patients (<i>P</i> < .01). At age 20, left and total testicular volumes were higher in the surgical group (17.9 ± 4.5 and 36.0 ± 8.8 mL) than in the nonsurgical group (15.8 ± 2.0 and 32.3 ± 4.1 mL, <i>P</i> < .001). Semen analyses (n = 82) indicated higher TMSC in patients who underwent surgery (5914.8 × 10⁶ vs 2124.5 × 10⁶, <i>P</i> < .001). Earlier surgery (elementary/junior high school) was associated higher adult testicular volume and TMSC compared with high school intervention. Eight patients (8%) showed no catch-up growth; 2 had Klinefelter syndrome. In this observational cohort, varicocelectomy was associated with improved testicular growth and higher spermatogenesis measures into adulthood. These findings highlight associations between timing of surgery and outcomes, supporting further investigation to inform optimal surgical indications.