Accumulating evidence from animal and human studies has demonstrated that varicoceles are associated with a time-dependent decline in testicular function.1-4 As a result, the finding of dilated scrotal veins, a varicocele, in an adolescent presents the practicing physician with a number of problems: When should one surgically intervene in the adolescent? Although infertility is not a presenting complaint, should prophylactic varicocele repair be performed to prevent future infertility and possible testosterone deficiency?

These questions can only be answered when we have a better understanding of the pathophysiology of the varicocele. The purpose of this review is to present the most current information on the adolescent varicocele, provide guidelines on managing this perplexing problem in the asymptomatic adolescent male, and stimulate future research about the enigmatic relationship between the varicocele and its effects on testicular growth and function.

Approximately 15% of all adult males have a varicocele.5 One-third of all males evaluated for infertility have a varicocele, demonstrating the negative impact of varicoceles on testicular function.6 However, only 15% to 20% of males with a varicocele seek treatment for infertility, suggesting that most males with a varicocele are fertile or do not seek treatment.

Although varicoceles have been reported in the preadolescent male, they are rare in this age group.7,8 In a survey by Oster9 (1971) of 1072 school boys in Denmark, there were no varicoceles found in 188 boys who were between the ages of 6 to 9 years. The incidence of varicoceles in the older child, (ages 10 to 25), varies between 9% to 25.8% with a weighted average of 16.3% (Table 1).9-14 This is similar to the incidence of varicoceles in the adult population and suggests that the physiologic changes associated with puberty, such as an increase in testicular …

The adolescent varicocele: what's new with an old problem in young patients?

https://www.urologic.theclinics.com/article/S0094-0143(02)00075-7/pdf

Varicocele: current concepts in pathophysiology, diagnosis, and treatment.

Varicocele, whose association with male infertility has been clearly documented in the literature, is a common finding in adolescents and adult men, being diagnosed in 20–40% of infertile patients. A correct and early diagnosis of this affliction is of great importance because, in most cases, a timely correction, usually performed using percutaneous sclerotherapy, leads to an improvement in semen quality. Currently, physical examination in a warm room is the mainstay of diagnosis, but this is affected by a low sensibility and specificity, especially in cases of low grade varicocele. Colour Doppler ultrasound (CDU) is a new, reliable and non-invasive diagnostic method for the evaluation of varicocele testes which allows the detection of even subclinical varicocele thanks to its capacity for measuring the size of the pampiniformis plexus and blood flow parameters of the spermatic veins. At present, there is a lack of completely standardised diagnostic criteria, but when this problem is solved, clinical examination and CDU will certainly become the “gold standard” in the investigation of varicocele.

Color Doppler ultrasound investigation of varicocele.

The finding of varicocele in an adolescent male is common. Varicocele rarely causes symptoms and is often diagnosed on the routine physical examination. There is clear association between varicocele and male factor infertility; however, there is debate about whether, when, and whom to treat when present in adult or adolescent males. This review of the epidemiology, etiology, pathophysiology, and treatment of the adolescent with varicocele will provide the reader with tools to make appropriate decisions in dealing with this condition.

Current Management of Adolescent Varicocele

https://www.urologic.theclinics.com/article/S0094-0143(04)00065-5/pdf

M. Mohi-el-Din

Papers

Testicular veins: anatomy and role in varicocelo genesis and other pathologic conditions