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Varikozele bei Kindern und Jugendlichen – wann konservativ, wann operativ?

Varicocele in children and adolescents—conservative vs. surgical treatment?

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Zusammenfassung

Die Prävalenz der Varikozele bei Kindern beträgt <1 %, bei Jugendlichen 8–14 %. Bis zu 15 % der Patienten mit Varikozele haben Fertilitätsstörungen. Nach wie vor wird die Indikation zur Therapie kontrovers diskutiert. In Studien wurden bisher Hodenvolumen bzw. Hodenvolumendifferenz, Spermiogramm bzw. Fertilität, Hormonstatus und Schmerzen untersucht. Die Studienlage ist für alle Parameter heterogen, sodass die Evidenz von Behandlungsempfehlungen sehr schwach ist. Die EAU-Guidelines (European Association of Urology) empfehlen dennoch die Therapie von Varikozelen bei Kindern und Jugendlichen im Falle von kleinen Hoden (Differenz >2 ml oder 20 %), zusätzlichem Hodenhochstand, bilateral tastbaren Varikozelen, symptomatischen Varikozelen und bei pathologischem Spermiogramm (bei älteren Jugendlichen). Mikrochirurgische inguinale und laparoskopische Verfahren mit Lymphgefäßschonung haben das geringste Persistenz- und Komplikationsrisiko.

Abstract

The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8–14%. Up to 15% of patients with varicocele have impaired fertility. The indication for therapy of varicocele is still controversially discussed. In clinical trials testicular volume, volume difference, semen quality, fertility, hormones and pain have been investigated. The results are very heterogeneous for all parameters, so that the evidence level of recommendations for therapy of varicocele is very low. Nevertheless, the EAU guidelines recommend therapy of varicocele in children and young adults in case of small testis (volume difference >2 ml or 20%), additional cryptorchism, bilateral palpable varicoceles, symptomatic varicoceles and in case of pathological semen (in older boys). Microsurgical inguinal and laparoscopic procedures with preservation of lymph vessels have the best success and lowest complication rates.

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Author information

Correspondence to Prof. Dr. T. Kälble.

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T. Yiakoumos und T. Kälble geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Yiakoumos, T., Kälble, T. Varikozele bei Kindern und Jugendlichen – wann konservativ, wann operativ?. Urologe (2020). https://doi.org/10.1007/s00120-020-01118-8

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Schlüsselwörter

  • Ejakulat
  • Plexus pampiniformis
  • Sonographie
  • Fertilität
  • Sklerosierung

Keywords

  • Semen quality
  • Plexus pampiniformis
  • Sonography
  • Fertility
  • Sclerosis