Impact of Varicocelectomy on Semen Quality in Adolescents with Grade 3 Varicocele: An Ultrasound-Based Study

This study evaluates the impact of varicocelectomy on semen parameters in adolescent boys with Grade 3 varicocele, focusing on potential improvements in fertility. Varicocele, a condition that can impair testicular function and sperm production, is often treated surgically through varicocelectomy, especially in cases showing severe abnormalities in semen analysis (SA). The study queried a registry of varicocele patients and identified 28 Tanner stage V adolescents with Grade 3 varicocele who underwent varicocelectomy between 2007 and 2022, with pre- and postoperative SA results available. Preoperative SA was conducted within 12 months prior to surgery, and the best result was considered for analysis. The patients, averaging 17.8 years of age, primarily underwent microscopic subinguinal varicocelectomy, with one case treated by percutaneous embolization. Complications were rare, with only one Clavien-Dindo grade 3b complication requiring additional surgery for hematoma. Following surgery, 82% of patients exhibited improvements in semen parameters, and 57% achieved normal postoperative semen parameters (total motile sperm count above 9 million). The analysis revealed significant increases in sperm motility (an 11.9% improvement), total sperm count (an increase of 9.7 million), and total motile sperm count (an increase of 8 million), with respective p-values of 0.03, 0.01, and 0.003, all indicating statistical significance. These findings suggest that varicocelectomy in adolescents with Grade 3 varicocele can significantly enhance semen parameters, thus potentially improving fertility outcomes. This supports the practice of considering varicocelectomy as a treatment option for young patients with severe varicocele who may face fertility challenges in the future.