Fatherhood can follow fix of teens' testis problem

An abnormality of the blood vessels in the testis can lead to infertility, but a new report shows that fertility can be saved when the problem is dealt with during adolescence.

A varicocele is an abnormal dilation of the veins of the spermatic cord that results in impaired blood supply to the testicle, which in turn can affect the production of sperm.

If varicocele repair is postponed until adulthood, only about half of patients who undergo the procedure regain the ability to father children, Dr. Kenneth I. Glassberg and colleagues explain in their article in the medical journal Pediatrics.

Reversal of testicular shrinkage does not usually occur after varicocele repair (called varicocelectomy) in adulthood. Glassberg's team reports that testicular growth seems to be sustained, and fertility preserved, when the condition is fixed during adolescence.

Repairing a varicocele in adolescence has become more frequent over the last decade, the researchers note, but there are no long-term follow-up studies on subsequent paternity in such patients.

Glassberg, at Columbia University in New York, and his associates followed 43 teens who had been treated at an average age of 15, for an average of 9 years.

Of 11 patients with a significant difference in size between the two testicles, catch-up growth occurred in nine. There were also two patients who had two small testicles who underwent a double repair, and in both cases their testicles then grew appropriately, the investigators found.

Of the 18 subjects who attempted to father a child, all were successful within a year.

"We contend that varicocelectomy in adolescence at worst does no harm and at best preserves fertility and testicular growth," Glassberg's group writes.

"Examination of the adolescent male to identify the presence of varicocele should be routine for the practicing pediatrician," Dr. A. Barry Belman, a pediatric urologist at George Washington University in Washington, DC, comments in a related editorial.

SOURCE: Pediatrics, December 2004.