Varikozele im Jugendalter, wenn ja, wann und wie? Kontra OP

Zusammenfassung

Die verfügbaren Indikatoren, die eine Therapie der Varikozele beim Adoleszenten rechtfertigen sollen, sind unzureichend: Das Hodenvolumen ist als störanfälliger Messparameter variabel, eine Hodenvolumendifferenz kann physiologisch sein; Hodenvolumen und Samenparameter unterliegen der pubertären Entwicklung. Beide Parameter sollten von daher prospektiv und zu mehreren Zeitpunkten gemessen werden, um eine klare Aussage im Hinblick auf eine mögliche Funktionseinschränkung der Hoden durch eine Varikozele treffen zu können. Nahezu unbeachtet sind endokrine Parameter der Hodenentwicklung, die möglicherweise pathologische Abweichungen anzeigen könnten. Völlig unklar ist der postulierte positive Effekt auf die spätere Fertilität der Betroffenen im Erwachsenenalter: Die wenigen vorliegenden Studien können nicht zeigen, dass eine effektive Prävention einer späteren Fertilitätseinschränkung durch eine frühzeitige Therapie der Varikozele beim Jugendlichen möglich ist. Aus diesen Gründen müssen Risiken und Nutzen der Therapie sorgfältig abgewogen werden. Eine evidenzgesicherte Empfehlung zur Intervention beim Jugendlichen lässt sich aus der aktuellen Datenlage nicht ableiten.

Abstract

Available indicators to justify varicocele treatment in adolescents are insufficient: testis volume is a variable parameter, and testicular asymmetry may be physiological. Testis volume and semen parameters are subject to pubertal development. For evaluation of possible testicular impairment, both parameters should be measured prospectively and at consecutive points in time. Endocrine parameters, which might contribute to a better understanding of possible impairment of testicular function, are neglected in studies. No evidence exists to confirm that varicocele treatment during adolescence leads to the prevention of fertility impairment in adulthood. In summary, risks and benefits of varicocele treatment have to be considered. There is no clear evidence-based recommendation to treat adolescents with varicocele.

Schlüsselwörter

Varikozele - adoleszent - Operation

Keywords

varicocele - adolescent - surgery

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