High varicocele prevalence in young men in eastern China: a cross-sectional study of 1468 men

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• 作者：Chenyi Jiang ; MD^a ; Shaoqing Liu ; MD^b ; Guohua Sun ; MD^c ; Shujie Xia ; Dr MD^a ; ^{xsjurologist@163.com" class="auth_mail" title="E-mail the corresponding author} ; Dr Fujun Zhao ; MD^a ; ^{drzhaofujun@yahoo.com" class="auth_mail" title="E-mail the corresponding author}
• 刊名：The Lancet
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：386
• 期：supp_S1
• 页码：S76
• 全文大小：52 K

文摘

Varicocele is a dilation of the pampiniform venous plexus within the scrotum. The prevalence of varicocele in peripubertal men has been reported to vary between 3% and 43%, which is higher than other urogenital diseases. Since its onset has a close relation with male infertility, study of its incidence, pathogenic mechanisms, and efficient therapeutic regimens is important. Prevalence of varicocele in China, especially in rural or underdeveloped areas, has seldom been reported. The aim of this study was to determine the prevalence and risk factors of varicocele in young men.

Methods

1468 young men (aged 16–25 years) from a county in Shandong province, China, who participated in the military conscription physical examination in August, 2013, and August, 2014, were examined for varicocele. 1270 (86·5%) men were from adjacent rural areas of the county, and the remaining (198 [13·5%]) were from the urban area. The participants were generally healthy. Their medical history, weight, height, body-mass index (BMI), urogenital symptoms, and ultrasonography data were obtained. This study was approved by the ethics committee of Ningyang First People's Hospital, Taian, China. All participants or their guardians consented verbally to this study before the examination procedures.

Findings

Varicocele was reported in 482 (32·8%) men, which is higher than previous reports from other countries (eg, 3·58% in Israel, 5·96% in Turkey, and 18·9% in the USA). 78 patients (5·3%) had grade 1 varicocele, 296 (20·2%) had grade 2 disease, 93 (6·3%) had grade 3 varicocele, and 15 (1·0%) had received surgical repair. Statistical analysis showed that low BMI significantly contribute to the onset of varicocele (odds ratio [OR] 0·893 [95% CI 0·849–0·965]; p<0·0008) and grades of varicocele (mean BMI of grade 1 21·9 kg/m² [SD 2·72], grade 2 21·7 kg/m² [3·30], and grade 3 20·6 kg/m² [2·93]; p=0·007). The symptoms of urogenital infections were reported in 283 (58·7%) of 482 who had varicocele. Mean diagram of spermatic vein was 1·97 mm (SD 0·46) in grade 1 varicocele, 2·18 mm (SD 0·34) in grade 2 disease, and 2·94 mm (SD 0·70) in grade 3 varicocele. 50 (64·1%) of men with grade 1 varicocele, 277 (93·6%) with grade 2 disease, and 93 (100·0%) with grade 3 varicocele could be traced with Doppler blood reflux signal.

Interpretation

High varicocele prevalence in China could result from the lean body figure typical of young Chinese men. However, socioeconomic background, lifestyle changes, or absence of physical exercise might also contribute to the occurrence of varicocele in young men. The physical and mental health, especially reproductive health, of young people would always be an important subject that cannot be ignored for the whole society. Active prevention (eg, health education) and efficient treatment protocols (eg, microsurgical varicocelectomy) should be introduced to the areas with high varicocele incidence. Further investigation of the relation between varicocele, testis volume, and sperm quality is warranted for peripubertal men in those areas.

Funding

None.