INFLUENCE OF THE DEGREE OF PROGRESSION OF VARICOCELE ON THE REPRODUCTIVE HEALTH OF ADOLESCENTS
Authors:   Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Pichugova Svetlana V. , Belyaeva Svetlana V. ,   State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center Yekaterinburg”, Rybina Irina V. ,   State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center Yekaterinburg”, Komarova Svetlana Yu. ,   Federal State Budgetary Educational Institution of Higher Education Ural State Medical University of the Ministry of Health of the Russian Federation, Chereshnev Valery A. ,   Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences
Published: February 2024

The main pathogenetic mechanisms of deterioration of reproductive function in varicocele under conditions of hyperthermia, ischemia and hypoxia of the testicular tissue are considered to be a violation of the endocrine function of the testicles as a result of alteration of Leydig cells, the development of an autoimmune form of infertility due to damage to Sertoli cells and the hematotesticular barrier, damage to the germinal epithelium of the seminiferous tubules can lead to disruption of spermatogenesis. The question of the influence of the degree of progression of varicocele on the severity of testicular dysfunction has not been fully studied. Purpose of the study. To assess the impact of the degree of varicocele progression on the reproductive health of adolescents from 14 to 17 years of age. Materials and methods. Adolescents with II and III degrees of varicocele after laparoscopic varicocelectomy from 14 to 17 years of age once annually performed a determination of the level of antisperm antibodies (ASAT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, estradiol in the blood serum. When the subject reached the age of 17 years, a semen analysis was performed. Results and discussion. During the observation period, the levels of all studied hormones, with the exception of estradiol, were within the reference interval, and their dynamics reflects the active puberty period. Monitoring of the ACAT level made it possible to establish its increase, but the values did not exceed diagnostically significant values. The study of the spermogram showed that the values of all parameters are within the reference interval. The results of the study were compared and evaluated depending on the degree of progression of varicocele. There was no statistically significant difference between the subgroups in the levels of hormones and ASAT. In terms of spermogram in patients with III degree of varicocele, statistically significantly lower indicators of ejaculate volume, concentration and total number of spermatozoa were established, in general, no critical violation of spermatogenesis was recorded. Conclusion. The conducted study on the assessment of the influence of the degree of varicocele progression on indicators reflecting the state of the reproductive function of adolescents made it possible to establish that, compared with grade II varicocele, with grade III varicocele, statistically significantly lower values were determined only for the following indicators: spermatozoa concentration (84.96 + 55.68 and 62.80 + 41.60; p≤0.025), total sperm count (221.07 + 171, 89 and 144.85 + 153.93, p≤0.021). At the same time, normozoospermia is most often diagnosed in all adolescents during this period. The frequency of occurrence of such a conclusion was 65.3% of cases with grade II varicocele and 39.21% of cases with grade III varicocele, in adolescents without varicocele — 63.3%. In all other studied parameters, there were no statistically significant differences depending on the degree of varicocele. The indicators of all determined parameters, including spermograms, were within the age reference intervals and their diagnostically significant deviation was not recorded. Based on the data obtained, it can be assumed that the degree of progression of varicocele in adolescents does not adversely affect the endocrine function of the testis, the hematotesticular barrier and spermatogenesis in the age period from 14 to 17 years.