Correlation of testicular volume, histology and LHRH test in adolescents with idiopathic varicocele.

Testicular growth failure as well as a well-documented histological damage have been reported in adolescents with varicocele. However, the proper management of this disorder in childhood is still debated due to the lack of seminal data and to the large number of adults with varicocele who have no fertility problems. In order to identify the subset of patients who are at risk of developing impaired testicular function and thus candidates for early varicocelectomy, we have studied 15 adolescents 10-17 years old with a grade II-III left-sided varicocele. Testicular volume and gonadotropin response to LHRH stimulation were evaluated preoperatively and compared to the histological findings from bilateral testicular biopsies. An abnormal left testicular histology was observed in 7 boys (46.6%) but only 3 of them (20%) showed severe testicular damage. The difference in size between the right and the left testis was never significant and was of no value in detecting subjects with abnormal histology. A good correlation was found between testicular injury and an increased response of both gonadotropins to the administration of LHRH. Decreased testicular volume does not seem to be a reliable predictor of early testicular damage. The assessment of gonadotropin response to LHRH may provide an additional objective means of evaluating adolescents with varicocele.