Adjunctive supplementation with vitamin E, zinc, L-arginine, L-citrulline, coenzyme Q10, and selenium enhances testicular recovery after Palomo varicocelectomy with indocyanine green in adolescents: a retrospective analysis

Varicocele in adolescents is associated with impaired testicular development and reduced fertility potential. Indocyanine green (ICG)- assisted Palomo varicocelectomy improves surgical precision by enhancing lymphatic visualization, but the contribution of postoperative nutraceutical supplementation to testicular recovery remains uncertain. A retrospective comparative analysis was conducted on sixty adolescents undergoing Palomo varicocelectomy. Thirty patients treated in 2024 received postoperative oral supplementation with vitamin E, zinc (gluconate), L-arginine, L-citrulline, coenzyme Q10, and selenium (G1), while thirty patients operated in 2022 received no supplementation (G2). Semen analysis, ultrasonographic evaluation, and clinical assessment were performed preoperatively and at 12 months postoperatively to compare outcomes between the groups. G1 demonstrated greater improvements in sperm concentration, progressive motility, and morphology at 12 months compared with G2. Testicular ultrasonography revealed similar postoperative reductions in varicocele grade in both groups, with a minimal increase in testicular volume in G1. No adverse effects or differences in postoperative complications were observed. Adjunctive antioxidant and metabolic supplementation appear to enhance both structural and functional testicular recovery after ICG-assisted Palomo varicocelectomy in adolescents. Further randomized studies are needed to confirm these findings and assess long-term reproductive outcomes.