Abstract
The primary reason to diagnose and treat varicoceles in adolescents is to prevent future infertility.
Secondary reasons:
-
1.
Relieve testicular pain.
-
2.
Correct the abnormal appearance of the left scrotum with grade 3 varicoceles.
Evidence for these aims:
-
Evidence that treatment of varicoceles in adolescents reduces or prevents adult infertility is lacking.
-
Treatment recommendations currently are based on semen parameters and/or left testicular volume loss, variously described as >2 mL, >10 %, or >20 %.
-
Most adolescents with varicoceles do not have decreased testicular volume compared to controls. Up to 50 % of those with decreased left testicular volume on initial assessment have been reported to have spontaneous improvement within 1–2 years of observation. Up to 33 % of those with initial volume differences <20 % are reported to develop volume discrepancy >20 % within 1–2 years.
-
Relationship between any extent of volume difference between the left and right testis with impaired semen parameters is poorly established in both adolescents and adults with varicoceles.
-
Use of >10 % or >20 % volume discrepancy as an indication for surgery is not based on known infertility risks.
-
There are limited semen analysis data in adolescents with varicoceles, with two studies reporting normal sperm densities but decreased motility and normal morphology, and one reporting decreased sperm density but normal motility and morphology.
-
Our review found only a single study involving 33 adolescents with preoperative and postoperative semen analysis that indicated improved sperm density and motility.
-
Three retrospective studies reported pain relief from varicocelectomy in from 68 to 97 %.
-
One retrospective study stated that 87 % of teens had resolution of the scrotal mass with varicocelectomy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol. 2011;59(3):455–61.
Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M. The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. BJU Int. 2000;86(4):490–3.
Anderson JE, Farr SL, Jamieson DJ, Warner L, Macaluso M. Infertility services reported by men in the United States: national survey data. Fertil Steril. 2009;91(6):2466–70.
Andrade-Rocha FT. Significance of sperm characteristics in the evaluation of adolescents, adults and older men with varicocele. J Postgrad Med. 2007;53(1):8–13.
Arai T, Kitahara S, Horiuchi S, Sumi S, Yoshida K. Relationship of testicular volume to semen profiles and serum hormone concentrations in infertile Japanese males. Int J Fertil Womens Med. 1998; 43(1):40–7.
Baek M, Park SW, Moon KH, Chang YS, Jeong HJ, Lee SW, et al. Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: a population based study. Int J Urol. 2011;18(1):55–60.
Beutner S, May M, Hoschke B, Helke C, Lein M, Roigas J, et al. Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures. Surg Endosc. 2007;21(1):61–5.
Borruto FA, Impellizzeri P, Antonuccio P, Finocchiaro A, Scalfari G, Arena F, et al. Laparoscopic vs open varicocelectomy in children and adolescents: review of the recent literature and meta-analysis. J Pediatr Surg. 2010;45(12):2464–9.
Cayan S, Acar D, Ulger S, Akbay E. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol. 2005;174(5):2003–6. discussion 6–7.
Diamond DA, Paltiel HJ, DiCanzio J, Zurakowski D, Bauer SB, Atala A, et al. Comparative assessment of pediatric testicular volume: orchidometer versus ultrasound. J Urol. 2000;164(3 Pt 2):1111–4.
Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev (Online). 2009;(1):CD000479.
Feneley MR, Pal MK, Nockler IB, Hendry WF. Retrograde embolization and causes of failure in the primary treatment of varicocele. Br J Urol. 1997;80(4):642–6.
Ficarra V, Sarti A, Novara G, Dalpiaz O, Galfano A, Cavalleri S, et al. Modified antegrade scrotal sclerotherapy in adolescent patients with varicocele. J Pediatr Surg. 2004;39(7):1034–6.
Glassberg KI, Poon SA, Gjertson CK, DeCastro GJ, Misseri R. Laparoscopic lymphatic sparing varicocelectomy in adolescents. J Urol. 2008;180(1):326–30. discussion 30–1.
Glassberg KI, Badalato GM, Poon SA, Mercado MA, Raimondi PM, Gasalberti A. Evaluation and management of the persistent/recurrent varicocele. Urology. 2011;77(5):1194–8.
Granata C, Oddone M, Toma P, Mattioli G. Retrograde percutaneous sclerotherapy of left idiopathic varicocele in children: results and follow-up. Pediatr Surg Int. 2008;24(5):583–7.
Keene DJ, Sajad Y, Rakoczy G, Cervellione RM. Testicular volume and semen parameters in patients aged 12 to 17 years with idiopathic varicocele. J Pediatr Surg. 2012;47(2):383–5.
Kim J, Shin JH, Yoon HK, Ko GY, Gwon DI, Kim EY, et al. Persistent or recurrent varicocoele after failed varicocoelectomy: outcome in patients treated using percutaneous transcatheter embolization. Clin Radiol. 2012;67(4):359–65.
Korets R, Woldu SL, Nees SN, Spencer BA, Glassberg KI. Testicular symmetry and adolescent varicocele—does it need followup? J Urol. 2011;186 (4 Suppl): 1614–8.
Kumanov P, Robeva RN, Tomova A. Adolescent varicocele: who is at risk? Pediatrics. 2008;121(1):e53–7.
Lee HJ, Cheon SH, Ji YH, Moon KH, Kim KS, Park S. Clinical characteristics and surgical outcomes in adolescents and adults with varicocele. Korean J Urol. 2011;52(7):489–93.
Li F, Chiba K, Yamaguchi K, Okada K, Matsushita K, Ando M, et al. Effect of varicocelectomy on testicular volume in children and adolescents: a meta-analysis. Urology. 2012;79(6):1340–5.
Liang Z, Guo J, Zhang H, Yang C, Pu J, Mei H, et al. Lymphatic sparing versus lymphatic non-sparing laparoscopic varicocelectomy in children and adolescents: a systematic review and meta-analysis. Eur J Pediatr Surg. 2011;21(3):147–53.
May M, Johannsen M, Beutner S, Helke C, Braun KP, Lein M, et al. Laparoscopic surgery versus antegrade scrotal sclerotherapy: retrospective comparison of two different approaches for varicocele treatment. Eur Urol. 2006;49(2):384–7.
Mazzoni G, Fiocca G, Minucci S, Pieri S, Paolicelli D, Morucci M, et al. Varicocele: a multidisciplinary approach in children and adolescents. J Urol. 1999;162(5):1755–7. discussion 7–8.
Mori MM, Bertolla RP, Fraietta R, Ortiz V, Cedenho AP. Does varicocele grade determine extent of alteration to spermatogenesis in adolescents? Fertil Steril. 2008;90(5):1769–73.
Mottrie AM, Matani Y, Baert J, Voges GE, Hohenfellner R. Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence. Br J Urol. 1995;76(1):21–4.
Paduch DA, Niedzielski J. Semen analysis in young men with varicocele: preliminary study. J Urol. 1996;156(2 Pt 2):788–90.
Paduch DA, Niedzielski J. Repair versus observation in adolescent varicocele: a prospective study. J Urol. 1997;158(3 Pt 2):1128–32.
Paltiel HJ, Diamond DA, Di Canzio J, Zurakowski D, Borer JG, Atala A. Testicular volume: comparison of orchidometer and US measurements in dogs. Radiology. 2002;222(1):114–9.
Pasqualotto FF, Lucon AM, de Goes PM, Sobreiro BP, Hallak J, Pasqualotto EB, et al. Semen profile, testicular volume, and hormonal levels in infertile patients with varicoceles compared with fertile men with and without varicoceles. Fertil Steril. 2005;83(1):74–7.
Podkamenev VV, Stalmakhovich VN, Urkov PS, Solovjev AA, Iljin VP. Laparoscopic surgery for pediatric varicoceles: randomized controlled trial. J Pediatr Surg. 2002;37(5):727–9.
Poon SA, Gjertson CK, Mercado MA, Raimondi PM, Kozakowski KA, Glassberg KI. Testicular asymmetry and adolescent varicoceles managed expectantly. J Urol. 2010;183(2):731–4.
Preston MA, Carnat T, Flood T, Gaboury I, Leonard MP. Conservative management of adolescent varicoceles: a retrospective review. Urology. 2008;72(1):77–80.
Rais-Bahrami S, Montag S, George AK, Rastinehad AR, Palmer LS, Siegel DN. Angiographic findings of primary versus salvage varicoceles treated with selective gonadal vein embolization: an explanation for surgical treatment failure. J Endourol. 2012;26(5):556–60.
Sakamoto H, Saito K, Ogawa Y, Yoshida H. Testicular volume measurements using Prader orchidometer versus ultrasonography in patients with infertility. Urology. 2007a;69(1):158–62.
Sakamoto H, Saito K, Oohta M, Inoue K, Ogawa Y, Yoshida H. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology. 2007b;69(1):152–7.
Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and varicocele in patients with infertility. Urology. 2008;71(1):104–9.
Schiff JD, Li PS, Goldstein M. Correlation of ultrasonographic and orchidometer measurements of testis volume in adults. BJU Int. 2004;93(7):1015–7.
Schwentner C, Radmayr C, Lunacek A, Gozzi C, Pinggera GM, Neururer R, et al. Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial. BJU Int. 2006;98(4):861–5.
Shiraishi K, Takihara H, Matsuyama H. Effects of grade 1 varicocele detected in the pediatric age-group on testicular development. J Pediatr Surg. 2009;44(10):1995–8.
Sigman M, Jarow JP. Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. J Urol. 1997;158(2):605–7.
Spinelli C, Di Giacomo M, Lo Piccolo R, Martin A, Messineo A. The role of testicular volume in adolescents with varicocele: the better way and time of surgical treatment. J Urol. 2010;184(4 Suppl):1722–6.
Thomas JC, Elder JS. Testicular growth arrest and adolescent varicocele: does varicocele size make a difference? J Urol. 2002;168(4 Pt 2):1689–91.
WHO (World Health Organization). The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril. 1992;57(6):1289–93.
Yaman O, Ozdiler E, Anafarta K, Gogus O. Effect of microsurgical subinguinal varicocele ligation to treat pain. Urology. 2000;55(1):107–8.
Zampieri N, Cervellione RM. Varicocele in adolescents: a 6-year longitudinal and followup observational study. J Urol. 2008;180(4 Suppl):1653–6. discussion 6.
Zampieri N, Zuin V, Corroppolo M, Chironi C, Cervellione RM, Camoglio FS. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. J Androl. 2007;28(5):727–33.
Zampieri N, Ottolenghi A, Camoglio FS. Painful varicocele in pediatric age: is there a correlation between pain, testicular damage and hormonal values to justify surgery? Pediatr Surg Int. 2008;24(11):1235–8.
Zaupa P, Mayr J, Hollwarth ME. Antegrade scrotal sclerotherapy for treating primary varicocele in children. BJU Int. 2006;97(4):809–12.
Zucchi A, Mearini L, Mearini E, Fioretti F, Bini V, Porena M. Varicocele and fertility: relationship between testicular volume and seminal parameters before and after treatment. J Androl. 2006;27(4):548–51.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Jacobs, M.A. (2013). Varicocele. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_8
Download citation
DOI: https://doi.org/10.1007/978-1-4614-6910-0_8
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-6909-4
Online ISBN: 978-1-4614-6910-0
eBook Packages: MedicineMedicine (R0)