ARC Journal of Urology

AUTHOR DETAILS

Giorgio Bolla*, Gianluca Sartore

Department of Paediatric Urology – O.C. Dolo (Venice, Italy)
*[email protected]

KEYWORDS

Paediatric disease – Varicocele – Oxidative stress

INTRODUCTION

Varicocele is a physical abnormality found in the 11% of adult males [1] and in the 25% of those with abnormal semen analysis [2]. Varicocele is a meshwork of distended blood vessels in the scrotum – usually on the left-side – due to dilatation of the spermatic vein. Although the concept that varicocele causes male subfertility has been around for more than 50 years, the mechanism by which varicocele would affect fertility is not yet clear. Therefore there isn’t any sufficient evidence to explain the mechanisms by which varicocelectomy would restore fertility. Furthermore, it has been questioned whether it exists a cause at all between the distension of the pampiniform plexus (a network of many small veins found in the human male spermatic cord) and impairment of fertility. The therapeutic approach for adolescent varicocele remains that of the patient to undergo several treatments, to be compared according to safety and effectiveness [3].

BACKGROUND

Varicocele is an anatomic and functional anomaly which reveals itself in predisposed boys and in different times. The Authors valued if there were some conditions able to make easier the appearance of paediatric varicocele; the main correlative interest was about sports [4,5]

MATERIALS AND METHODS

117 boys suffering from left idiopathic varicocele – second and third degree – were treated by specific therapy: 62 with high ligature of spermatic vessels and 55 with antegrade sclerotherapy (Fig. 1). The range of age in the treated boys was 11-14 years old (13 boys-11 years old; 18 boys-12 years old; 34 boys-13 years old; 52 boys-14 years old). We obtained the informed consent by the parents and the ethics approval according to Helsinki Declaration.

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Figure1. Different treatments for the left varicocele

RESULTS

83 boys of the whole treated group carried on the sports continuously – 71% - , while a clear minority – 34 boys (29%) – didn’t effect any sporting activity (Fig. 2). Different sporting activities were represented, mostly the football and the cycling. A continuative sporting activity represents the engagement for three days/week and eleven months/year, at least.

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Figure2. Frequency of sporting activity in the treated boys

DISCUSSION

There is a clear variability on treatment of paediatric varicocele, still now [6]. This aspect indicates an uncertainty about the therapeutical approaches to the problem. The variability regards both the surgical treatments (like the ligature of the vessels or the veins on a different level and like the various vascular anastomoses) and the others therapies (antegrade or retrograde sclerotherapy, retrograde embolisation)[7]. In our opinion the treatment of paediatric varicocele ought to be done at the first diagnosis, in order to prevent a possible future infertility [8] thus allowing the regular testicular growth⁹. Unavoidably for adolescents the functional fertility evaluation is not possible, for ethical reasons and physical ones (hormone release). The sports can signify an increase of the oxidative cellular stress, with possible anomalies of the spermatogenesis and an appearance of vascular dilation [10].

CONCLUSION

It is reasonable to hypothesize, by our data (the low number of our sample not yet determines statistical settlements), a more frequent early manifestation of the idiopathic varicocele for the boys who carry on the sports continuously: the comparative frequency of the boys suffering from varicocele is higher than the general national frequency of the sporting adolescent