Current Issues in Adolescent Varicocele: Pediatric Urological Perspectives

Abstract

While varicocele is the most common cause of surgically correctable infertility in adult males, with repair resulting in improved semen parameters in 60% to 80% of men and a higher likelihood of conception in up to 60% of men, the rationale for varicocele repair in the pediatric population is less clear. Additionally, prepubertal varicoceles are much less common and their management is controversial. Adolescents with a varicocele are often in the midst of a progressive disease process. Despite the high prevalence of varicocele and its association with progressive disease processes, the indications for adolescent varicocele repair and the effects thereof on paternity have been persistently challenging to study. This review will briefly present some of the current issues regarding adolescent varicocele from a pediatric urological point of view, including the evaluation of adolescent varicocele, the optimal surgical indications, the optimal choice of surgical intervention to be performed, and outcomes.

Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective

“…Adolescent varicocele is more frequently asymptomatic, despite chronic fullness or swelling in the scrotum or the inguinal area can be reported by the patient [10]. It is more frequently left sided, mainly due to the anatomical differences between left and right venous drainage.…”

“…These factors cause increased pressure in the left scrotum vein, leading to varicose veins occurrence [18]. A total of 3% are bilaterally palpable [10,19].…”

“…This makes a standard approach more difficult. The current challenge is to establish which patient should be treated, when and what type of treatment should be preferred [10].…”

Varicocele in the adolescent population: challenges in management

“…For those patients, an ultrasound should be performed in order to identify potential retroperitoneal or renal masses that might be compressing the gonadal vein leading to elevated pressure in pampiniform plexus. Extension of Wilms tumor in renal vein or vena cava may also be related to a secondary varicocele [26][27][28][29] .…”

“…With testicular asymmetry being the principal clinical finding for indication, it is important to achieve more accuracy. Ultrasound allows the evaluation of a questionable physical examination, with more precise measurements of testicular volume and spermatic veins status 26 . Experience of the clinician and inter-examiner variability can influence both ultrasound and clinical measures, therefore, measurements should be analyzed over a period of time during follow-up by the same method.…”