Varikozele im Kindes- und Jugendalter

Zusammenfassung

Die Behandlung einer Varikozele im Kindes- und Jugendalter wird sehr kontrovers gesehen und diskutiert. Trotz des recht häufigen Befundes – früher wurde die Varikozele insbesondere im Rahmen der Musterung diagnostiziert; heute fällt die Varikozele zumeist im Rahmen der J1-Untersuchung auf – gibt es wenig evidenzbasierte Empfehlungen zur Behandlung. Dies bedeutet, dass Urologen und Kinderurologen zunehmend früher mit der Frage konfrontiert werden, ob eine Intervention notwendig ist oder nicht, ohne dass es hier klare Empfehlungen gibt.

Die Literatur hierzu ist sehr widersprüchlich. Systematische Reviews und Metaanalysen zeigten zuletzt, dass sich durch eine Intervention nur ein mäßiger Vorteil in Bezug auf die Hodengröße und die Qualität des Spermiogramms ergibt. Solide Daten bez. einer positiven Auswirkung auf die Vaterschaftsraten gibt es weiterhin nicht. Es zeigte sich jedoch, dass die Lymphgefäß-schonenden Techniken im Falle einer Intervention deutliche Vorteile haben.

Mögliche Indikationen für eine Intervention stellen eine persistierende Größendifferenz der Hoden (> 20 % über mindestens 6 Monate), eine symptomatische Varikozele (sehr subjektives Kriterium), ein (besser 2) pathologische Spermiogramme sowie ggf. das Vorhandensein von zusätzlich die Fertilität einschränkenden Faktoren dar.

Abstract

The treatment of a varicocele in childhood and adolescence is considered very controversial. In the past varicocele was often diagnosed during the medical examination for military purposes, but today varicocele is common in the J1 exam and is found rather frequently. However, we are still lacking evidence-based recommendations. This means that urologists and paediatric urologists are increasingly confronted with the question of whether intervention is necessary or not.

The literature on this is very contradictory. Systematic reviews and meta-analyses have recently shown that there are only modest benefits of intervention in terms of testicular size and spermiogram quality. Solid data on the impact on paternity rates are still lacking. However, it has been shown that if an intervention is to be made, the lymphatic sparing techniques have a distinct advantage.

Possible indications for intervention may be the persistent difference in size of the testes (> 20 % for at least 6 months), a symptomatic varicocele (very subjective criterion), a pathological spermiogram (better 2), and possibly the presence of additional fertility-limiting factors.

Schlüsselwörter

Varikozele - Jugendliche - operative Versorgung - Kindesalter

Keywords

varicocele - adolescent - pediatric - treatment

• Literatur

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