The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?

Abstract

The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.

Varicocele in the adolescent population: challenges in management

“…In pre-pubertal individuals, prevalence of varicocele in is low (<1% in boys under 10 years) 3 and increases during puberty to a prevalence of 15%, which is similar to that seen in adults 5 . Akbay et al 6 evaluated varicocele in 4092 boys aged 2-19 observing varicocele prevalence of < 1% in boys 2-10, 7.8% in boys between 11-14 and 14.1% in boys between 15-19 years old.…”

“…Previous studies by Diamond et al 38 and Mori et al 39 demonstrated lower sperm concentrations and lower progressive motility. Diamond et al 5 also reports correlation between testicular asymmetry and decrease in total motile count. Correlation between semen parameters and varicocele grade has not been established 5 .…”

“…Diamond et al 5 also reports correlation between testicular asymmetry and decrease in total motile count. Correlation between semen parameters and varicocele grade has not been established 5 .…”

“…Most of the patients are asymptomatic, with approximately 5% presenting with scrotal pain 5 . Dull ache or "scrotal heaviness" is often referred by patients with varicocele 30 .…”

“…Data from previous studies, although performed in adults, have demonstrated an overall resolution of 61-100%, specially for sharp pain. Other conservative treatments have not been as effective 5 .…”