Right Testicular Compensatory Hypertrophy: A New Concept in Varicocele
Authors: BOLAYIR KEMAL 
Published: October 2023

ABSTRACT: In this study, we have conducted a multivariative analysis of varicocele in young males. We carried out investigations on right testicular compensatory hypertrophy.

The results in 10 control cases were represented by excellent seminal quality and bilateral CTS(1.83). Twenty‐eight of 40 patients showed subnormal seminal quality, but in the other 12 patients seminal quality was normal. CTS of the left testicle in 28 men with subnormal seminal quality was 1.24 and on the right 1.89. On the other hand, the CTS of 12 patients with normal seminal quality was 1.11 in the left and 2.13 in the right testicle. Serum hormonal analysis of 40 men with varicocele and 10 men in the normal group showed normal findings. Twenty‐eight patients with varicocele and subnormal seminal quality showed relatively diminished diameter of seminiferous tubules and the number of cells in germinal epithelium, but at the same time showed in increase in interstitial substance in the left testicle. This was called hypospermatogenesis. The average diameter of the seminiferous tubules was found to be 91 ± 30 microns.

The right testicle showed normal histologic pattern. In the other 12 patients with varicocele and normal seminal quality, the histologic findings of the left testicle were almost the same as of those previously discussed 28 patients. But in eight of these men, the right testicle specimen showed relatively increased diameter of seminiferous (210 ± 50 microns), increased in the number of cells in the germinal epithelium, and also decreased distance between seminiferous tubules. The decrease in left testicular volume was directly related to the size of the pampiniform plexus. Sperm quality and quantity are impaired in one testicle if it is smaller than 14 ml (Kass and Belman, 1987). In our study, in 36 of 40 patients the volume of the left testicle was found to be smaller than 14 ml. All of these patients showed diminished sperm quality in the seminiferous tubules on biopsy. In 12 patients, CTS was observed to be decreased in the left and increased on the right in all but two. These findings support the hypothesis of right testicular compensatory hypertrophy and also suggest a reasonable cause for normal semen quality.

In fact, the explanations of unaffected seminal quality in unilateral testicular pathologies are conflicting (Hadziselimovic et al, 1992). Why did not all of the 40 patients with varicocele present with right compensatory hypertrophy in the face of the left testicular function reduction? We think further studies are needed to explain the mechanism of the right testicular compensatory hypertrophy with varicocele.

Forty men who had been diag nosed to have grade 3varicocele and 10 healthy men were included in this study. The clinical features of the 40 varicoceles were large, easily visible, and palpable lesions. Three subsequent semen analyses were investigated in accordance to the World Health Organization criteria (1985). Scrotal ultrasound was carried out and bilateral testicular volumes calculated by the formula of ellipsoid π/6×length×width (kass and Belman, 1987). Serum LH, FSH, prolactin, and testosterone were obtained. Palomo retroperitoneal varix ligation was used as the operative procedure, and during the operation pampiniform plexosographies were obtained. Bilateral testicular biopsies were carried out for testicular histology. Testicular volume was divided into body mass index, and we named this result as corrected testicle size (CTS). In our opinion, testicular volume measurements without respect to body mass would be inaccurate.