Mean Testicular Volume Increase After Varicocele Repair
Varicocele repair leads to an average increase in testicular volume of approximately 1.5 mL in the affected testicle, with total testicular volume improvements of about 2.4 mL when considering bilateral effects. 1
Testicular Volume Changes by Varicocele Grade
- The degree of testicular volume improvement after varicocele repair correlates with the initial grade of varicocele, with larger varicoceles showing more dramatic improvements in testicular size 2
- Grade I (small) varicoceles show minimal improvement in testicular volume that is not statistically significant 2
- Grade II (medium) and Grade III (large) varicoceles demonstrate statistically significant increases in testicular volume after repair (p<0.001) 2
- Men with large (Grade III) varicoceles typically have smaller preoperative testicular volumes compared to those with smaller varicoceles, indicating greater testicular growth arrest before treatment 2
Timeline and Pattern of Volume Recovery
- Testicular volume improvements typically parallel the timeline for semen parameter improvements, which take up to two spermatogenic cycles (approximately 3-6 months) to show enhancement 3
- Both the ipsilateral (affected) and contralateral testicles may show volume increases after varicocele repair, with the ipsilateral testicle showing an average increase of 1.5 mL 1
- Total testicular volume (both testes combined) increases by approximately 2.4 mL after varicocele repair 1
Clinical Implications
- For adolescents, the European Association of Urology strongly recommends surgery for varicocele when associated with a persistent small testis (size difference >2 mL or 20%), confirmed on two subsequent visits 6 months apart 4
- Testicular volume correlates significantly with total sperm count (r=0.445; p=0.01), suggesting that volume improvement may be a marker of improved testicular function 5
- Varicocele repair should only be performed in men with clinical varicoceles and abnormal semen parameters, as treatment of subclinical varicoceles or men with normal semen analysis is not recommended 4, 6
Special Considerations
- In cases of bilateral varicoceles (clinical left with subclinical right), repair of both varicoceles results in significant improvements in both testicular volumes and semen parameters 7
- Right testicular volume may not show significant improvement in all patient groups, particularly when only the left varicocele is treated 1
- Ultrasound evaluation provides the most accurate assessment of testicular volume changes after varicocele repair 5, 1
Factors Affecting Volume Recovery
- The preoperative grade of varicocele significantly influences the degree of volume recovery, with higher grades showing greater relative improvement 8, 2
- Even subclinical varicoceles may have detrimental effects on testicular volume, and repairing these can lead to significant improvements in testicular size and function 7
- The timing of surgery may influence outcomes, with earlier intervention potentially preventing permanent testicular damage 4