The Adolescent Varicocele: What's New With an Old Problem in Young Patients?

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 …