Epidemiology of Varicocele in Pediatric, Adolescent, and Adult Populations

  • Mohannad Alharbi
  • Armand Zini


Varicocele is a common problem in infertility practice. Varicocele is encountered in 15% of healthy men and up to 35% of men with primary infertility. In this chapter, we have identified the prevalence of varicocele among different populations. We also highlighted the importance of some associated conditions, such as venous insufficiency and body mass index. Moreover, there appears to be an increased risk in the occurrence of varicocele in relatives of patients with varicocele. Additional studies with larger samples are needed to demonstrate the specific factors associated with the increased prevalence of varicocele.


Epidemiology Infertility Varicocele 


  1. 1.
    Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian J Androl. 2016;18(2):179–81.CrossRefGoogle Scholar
  2. 2.
    Mehta A, Goldstein M. Microsurgical varicocelectomy: a review. Asian J Androl. 2013;15:56.CrossRefGoogle Scholar
  3. 3.
    Clavijo RI, Carrasquillo R, Ramasamy R. Varicoceles: prevalence and pathogenesis in adult men. Fertil Steril. 2017;108(3):364–9.CrossRefGoogle Scholar
  4. 4.
    Agarwal A, Hamada A, Esteves SC. Insight into oxidative stress in varicocele-associated male infertility: part 1. Nat Rev Urol. 2012 Dec;9(12):678–90.CrossRefGoogle Scholar
  5. 5.
    Serefoglu EC, Saitz TR, La Nasa JA Jr, et al. Adolescent varicocoele management controversies. Andrology. 2013;1:109–15.CrossRefGoogle Scholar
  6. 6.
    Zorgniotti AW, Macleod J. Studies in temperature, human semen quality, and varicocele. Fertil Steril. 1973;24:854–63.CrossRefGoogle Scholar
  7. 7.
    Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol. 1989;142:743–5.CrossRefGoogle Scholar
  8. 8.
    Saypol DC, Howards SS, Turne TT, Miller ED. Influence of surgically induced varicocele on testicular blood flow, temperature, and histology in adult rats and dogs. J Clin Invest. 1981;68:39–45.CrossRefGoogle Scholar
  9. 9.
    Ali JI, Weaver DJ, Weinstein SH, Grimes EM. Scrotal temperature and semen quality in men with and without varicocele. Arch Androl. 1990;24:215–9.CrossRefGoogle Scholar
  10. 10.
    Lima SB, Cenedeze MA, Bertolla RP, et al. Expression of the HSPA2 gene in ejaculated spermatozoa from adolescents with and without varicocele. Fertil Steril. 2006;86:1659–63.CrossRefGoogle Scholar
  11. 11.
    Ito H, Fuse H, Minagawa H, Kawamura K, Murakami M, et al. Internal spermatic vein prostaglandins in varicocele patients. Fertil Steril. 1982;37:218–22.CrossRefGoogle Scholar
  12. 12.
    Zini A, Boman JM. Varicocele: red flag or red herring? Semin Reprod Med. 2009;27:171–8.CrossRefGoogle Scholar
  13. 13.
    Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970;21:606–9.CrossRefGoogle Scholar
  14. 14.
    Saypol DC. Varicocele. J Androl. 1981;2:61–71.CrossRefGoogle Scholar
  15. 15.
    Clarke BG. Incidence of varicocele in normal men and among men of different ages. JAMA. 1966;198:1121–2.CrossRefGoogle Scholar
  16. 16.
    Steeno O, Knops J, Declerck L, Adimoelja A, van de Voorde H. Prevention of fertility disorders by detection and treatment of varicocele at school and college age. Andrologia. 1976;8:47–53.CrossRefGoogle Scholar
  17. 17.
    Oster J. Varicocele in children and adolescents. An investigation of the incidence among Danish school children. Scand J Urol Nephrol. 1971;5:27–32.CrossRefGoogle Scholar
  18. 18.
    Damsgaard J, Joensen UN, Carlsen E, Erenpreiss J, Blomberg Jensen M, Matulevicius V, et al. Varicocele is associated with impaired semen quality and reproductive hormone levels: a study of 7035 healthy young men from six European countries. Eur Urol. 2016;70:1019–29.CrossRefGoogle Scholar
  19. 19.
    Rais A, Zarka S, Derazne E, et al. Varicocoele among 1 300 000 Israeli adolescent males: time trends and association with body mass index. Andrology. 2013;1:663–9.CrossRefGoogle Scholar
  20. 20.
    Pfeiffer D, Berger J, Schoop C, et al. A Doppler-based study on the prevalence of varicocele in German children and adolescents. Andrologia. 2006;38:13.CrossRefGoogle Scholar
  21. 21.
    Kim HH, Goldstein M. Adult varicocele. Curr Opin Urol. 2008;18:608–12.CrossRefGoogle Scholar
  22. 22.
    Liu J, Zhang S, Liu M, Wang Q, Shen H, et al. Prevalence of varicocoele and its association with body mass index among 39,559 rural men in eastern China: a population-based cross-sectional study. Andrology. 2017;5(3):562–7.CrossRefGoogle Scholar
  23. 23.
    Soylemez H, Atar M, Ali Sancaktutar A, Bozkurt Y, Penbegul N. Varicocele among healthy young men in Turkey; prevalence and relationship with body mass index. Int Braz J Urol. 2012;38:116–21.CrossRefGoogle Scholar
  24. 24.
    Jacobson DL, Johnson EK. Varicoceles in the pediatric and adolescent population: threat to future fertility? Fertil Steril. 2017 Sep;108(3):370–7.CrossRefGoogle Scholar
  25. 25.
    Horner JS. The varicocele: a survey amongst secondary school boys. Med Officer. 1960;104:377–81.Google Scholar
  26. 26.
    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;86:490–3.CrossRefGoogle Scholar
  27. 27.
    El Gohary MA. Boyhood varicocele: an overlooked disorder. Ann R Coll Surg Eng. 1984;66:36–8.Google Scholar
  28. 28.
    Kumanov P, Robeva RN, Tomova A. Adolescent varicocele: who is at risk? Pediatrics. 2008;121(1):e53–7.CrossRefGoogle Scholar
  29. 29.
    Alukal JP, Zurakowski D, Atala A, Bauer SB, Borer JG, Cilento BG Jr, et al. Testicular hypotrophy does not correlate with grade of adolescent varicocele. J Urol. 2005;174:2367–70; discussion 2370CrossRefGoogle Scholar
  30. 30.
    Chu DI, Zderic SA, Shukla AR, Srinivasan AK, Tasian GE, Weiss DA, et al. The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: a retrospective cohort study. J Pediatr Urol. 2017;13:77.e1–5.CrossRefGoogle Scholar
  31. 31.
    Moursy EE, ElDahshoury MZ, Hussein MM, Mourad MZ, Badawy AA. Dilemma of adolescent varicocele: long-term outcome in patients managed surgically and in patients managed expectantly. J Pediatr Urol. 2013;9:1018–22.CrossRefGoogle Scholar
  32. 32.
    Kozakowski KA, Gjertson CK, Decastro GJ, Poon S, Gasalberti A, Glassberg KI. Peak retrograde flow: a novel predictor of persistent, progressive and new onset asymmetry in adolescent varicocele. J Urol. 2009;181:2717–22; discussion 2723CrossRefGoogle Scholar
  33. 33.
    Levinger U, Gornish M, Gat Y, Bachar GN. Is varicocele prevalence increasing with age? Andrologia. 2007;39:77–80.CrossRefGoogle Scholar
  34. 34.
    Canales BK, Zapzalka DM, Ercole CJ, Carey P, Haus E, et al. Prevalence and effect of varicoceles in an elderly population. Urology. 2005;66:627–31.CrossRefGoogle Scholar
  35. 35.
    Nielsen ME, Zderic S, Freedland SJ, Jarow JP. Insight on pathogenesis of varicoceles: relationship of varicocele and body mass index. Urology. 2006;68:392–6.CrossRefGoogle Scholar
  36. 36.
    Tulloch WS. A consideration of sterility factors in light of subsequent pregnancies. Edinburgh Med J. 1952;59:29–34.Google Scholar
  37. 37.
    Redmon JB, Carey P, Pryor JL. Varicocele-the most common cause of male factor infertility. Hum Reprod Update. 2002;8(1):53–8.CrossRefGoogle Scholar
  38. 38.
    Shafi H, Esmaeilzadeh S, Delavar MA, Haydari FH, Mahdinejad N, et al. Prevalence of varicocele among primary and secondary infertile men: Association with occupation, smoking and drinking alcohol. N Am J Med Sci. 2014;6(10):532–5.CrossRefGoogle Scholar
  39. 39.
    Pinto KJ, Kroovand RL, Jarow JP. Varicocele related testicular atrophy and its predictive effect upon fertility. J Urol. 1994;152:788–90.CrossRefGoogle Scholar
  40. 40.
    Safarinejad MR. Infertility among couples in a population-based study in Iran: prevalence and associated risk factors. Int J Androl. 2008;31:303–14.CrossRefGoogle Scholar
  41. 41.
    The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril. 1992;57:1289–93.Google Scholar
  42. 42.
    Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59:613–6.CrossRefGoogle Scholar
  43. 43.
    Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology. 1993;42:541–3.CrossRefGoogle Scholar
  44. 44.
    Jarow JP, Coburn M, Sigman M. Incidence of varicoceles in men with primary and secondary infertility. Urology. 1996;47:73–6.CrossRefGoogle Scholar
  45. 45.
    Jarow JP. Effects of varicocele on male fertility. Hum Reprod Update. 2001;7:59–64.CrossRefGoogle Scholar
  46. 46.
    Ziv Y, Livne PM, Siegenreich E, Zamir R, Servadio C. Familial varicocele. Panminerva Med. 1992;34:38–9.PubMedGoogle Scholar
  47. 47.
    Mohammadali Beigi F, Mehrabi S, Javaherforooshzadeh A. Varicocele in brothers of patients with varicocele. Urol J. 2007;4:33.PubMedGoogle Scholar
  48. 48.
    Raman JD, Walmsley K, Goldstein M. Inheritance of varicoceles. Urology. 2005;65:1186–9.CrossRefGoogle Scholar
  49. 49.
    Mokhtari G, Pourreza F, Falahatkar S, Kamran AN, Jamali M. Comparison of prevalence of varicocele in first-degree relatives of patients with varicocele and male kidney donors. Urology. 2008;71:666–8.CrossRefGoogle Scholar
  50. 50.
    Gökçe A, Davarci M, Yalçinkaya FR, Güven EO, Kaya YS, et al. Hereditary behavior of varicocele. J Androl. 2010;31:288–90.CrossRefGoogle Scholar
  51. 51.
    Dennison AR, Tibbs DJ. Varicocele and varicose veins compared a basis for logical surgery. Urology. 1986;28:211–7.CrossRefGoogle Scholar
  52. 52.
    Sakamoto H, Ogawa Y. Is varicocele associated with underlying venous abnormalities? Varicocele and the prostatic venous plexus. J Urol. 2008;180:1427–31.CrossRefGoogle Scholar
  53. 53.
    Ciaccio V, Ficola F, Ceccarelli F, et al. Assessment of sapheno-femoral junction continence in 42 patients with primary varicocele. Minerva Chir. 1995;50:469–73.PubMedGoogle Scholar
  54. 54.
    Bolcal C, Sargin M, Mataraci I, Iyem H, Doganci S, et al. Concomitance of varicoceles and chronic venous insufficiency in young males. Phlebology. 2006;21:65–9.CrossRefGoogle Scholar
  55. 55.
    Yasim A, Resim S, Sahinkanat T, Eroglu E, Ari M, et al. Clinical and subclinical varicocele incidence in patients with primary varicose veins requiring surgery. Ann Vasc Surg. 2013;27:758–61.CrossRefGoogle Scholar
  56. 56.
    Lai YW, Hsueh TY, Hu HY, Chiu YC, Chen SS, Chiu AW. Varicocele is associated with varicose veins: a populationbased casecontrol study. Int J Urol. 2015;22:972975.CrossRefGoogle Scholar
  57. 57.
    Yazici CM, Kayhan A, Malkoc E, Verim S. Varicocele and saphenofemoral reflux: are they coincidentally related? BJU Int. 2011;109:1853–6.CrossRefGoogle Scholar
  58. 58.
    Kiliç S, Aksoy Y, Sincer I, et al. Cardiovascular evaluation of young patients with varicocele. Fertil Steril. 2007;88:369.CrossRefGoogle Scholar
  59. 59.
    Lee JD, Yang WK, Lee TH. Increased expression of hypoxia-inducible factor-1alpha and Bcl-2 in varicocele and varicose veins. Ann Vasc Surg. 2012;26(8):1100–5.CrossRefGoogle Scholar
  60. 60.
    Smith SM. Body size and weight in relation to varicocoele and hernia. Ann Hum Genet. 1957;21:304–12.CrossRefGoogle Scholar
  61. 61.
    Delaney DP, Carr MC, Kolon TF, Snyder HM, Zderic SA. The physical characteristics of young males with varicocele. BJU Int. 2004;94:624–6.CrossRefGoogle Scholar
  62. 62.
    May M, Taymoorian K, Beutner S, Helke C, Braun KP, et al. Body size and weight as predisposing factors in varicocele. Scand J Urol Nephrol. 2006;40:45–8.CrossRefGoogle Scholar
  63. 63.
    Baek M, Park SW, Moon KH, Chang YS, Jeong HJ, et al. Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: a population based study. Int J Urol. 2011;18:55–60.CrossRefGoogle Scholar
  64. 64.
    Handel LN, Shetty R, Sigman M. The relationship between varicoceles and obesity. J Urol. 2006;176:2138–40.CrossRefGoogle Scholar
  65. 65.
    Prabakaran S, Kumanov P, Tomova A, Hubaveshki S, Agarwal A. Adolescent varicocele: Association with somatometric parameters. Urol Int. 2006;7:114–7.CrossRefGoogle Scholar
  66. 66.
    Tsao CW, Hsu CY, Chou YC, Wu ST, Sun GH, et al. The relationship between varicoceles and obesity in a young adult population. Int J Androl. 2009;32:385–90.CrossRefGoogle Scholar
  67. 67.
    Al-Ali BM, Marszalek M, Shamloul R, Pummer K, Trummer H. Clinical parameters and semen analysis in 716 Austrian patients with varicocele. Urology. 2010;75:1069–73.CrossRefGoogle Scholar
  68. 68.
    Gokce A, Demirtas A, Ozturk A, Sahin N, Ekmekcioglu O. Association of left varicocoele with height, body mass index and sperm counts in infertile men. Andrology. 2013;1:116–9.CrossRefGoogle Scholar
  69. 69.
    Walters RC, Marguet CG, Crain DS. Lower prevalence of varicoceles in obese patients found on routine scrotal ultrasound. J Urol. 2012;187:599–601.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mohannad Alharbi
    • 1
    • 2
  • Armand Zini
    • 1
  1. 1.Division of Urology, Department of SurgeryMcGill UniversityMontrealCanada
  2. 2.Department of Urology, College of MedicineQassim UniversityQassimSaudi Arabia

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