Effects of percutaneous varicocele repair on testicular volume and function: results from a 12-month follow-up

Varicocele – the excessive dilatation of the pampiniform venous plexus of the spermatic cord – is a common finding in males of reproductive age since adolescence. Its prevalence is debated, as estimates from different populations yield different results: however, it is usually reported that varicocele may occur in up to 15% of all males between 15 and 19 years, with a much lower prevalence before puberty. Testicular damage resulting from varicocele has been variably associated with reduced testicular volume, impaired spermatogenesis, and increased sperm DNA damage, although the mechanisms involved are still not completely understood. It is therefore unsurprising that it is listed as one of the most frequent causes of male infertility and that its prevalence is much higher in infertile men, at 30-40% in primary and 80-85% in secondary infertility. Existing guidelines propose different approaches on when and how to treat varicocele. Reduced ipsilateral testicular size is one of the indications for treatment, above all in adolescents. As 80-90% of testicular volume is made up of germ cells within seminiferous tubules, an asymmetrical reduction in testicular volume is universally accepted as a sign of testicular damage. Improvements in testicular volume, sperm parameters and DNA fragmentation have been variably reported following surgical treatment of varicocele; however, to our knowledge, no study has yet described the long-term effects of percutaneous varicocele embolization on testicular volume or function. As this treatment is regularly used in clinical practice, we retrospectively assessed testicular volume catch-up growth and changes in testicular function during a 12-month follow-up in a single center protocol-driven study.