World J Mens Health.  2018 May;36(2):123-131. 10.5534/wjmh.170053.

Current Issues in Adolescent Varicocele: Pediatric Urological Perspectives

• Chung JM
• Lee SD

• KMID: 2419310
• DOI: http://doi.org/10.5534/wjmh.170053

Abstract

While varicocele is the most common cause of surgically correctable infertility in adult males, with repair resulting in improved semen parameters in 60% to 80% of men and a higher likelihood of conception in up to 60% of men, the rationale for varicocele repair in the pediatric population is less clear. Additionally, prepubertal varicoceles are much less common and their management is controversial. Adolescents with a varicocele are often in the midst of a progressive disease process. Despite the high prevalence of varicocele and its association with progressive disease processes, the indications for adolescent varicocele repair and the effects thereof on paternity have been persistently challenging to study. This review will briefly present some of the current issues regarding adolescent varicocele from a pediatric urological point of view, including the evaluation of adolescent varicocele, the optimal surgical indications, the optimal choice of surgical intervention to be performed, and outcomes.

Keyword

Adolescent; Diagnosis; Infertility; Therapeutics; Treatment; Varicocele

MeSH Terms

Adolescent*
Adult
Diagnosis
Fertilization
Humans
Infertility
Male
Paternity
Prevalence
Semen
Varicocele*

Reference

1. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007; 70:532–538.

2. Goldstein M. Surgical management of male infertility. In : Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. Philadelphia: Elsevier Saunders;2012. p. 648–687.

3. Chiba K, Ramasamy R, Lamb DJ, Lipshultz LI. The varicocele: diagnostic dilemmas, therapeutic challenges and future perspectives. Asian J Androl. 2016; 18:276–281.

4. 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; 86:490–493.

5. Kumanov P, Robeva RN, Tomova A. Adolescent varicocele: who is at risk? Pediatrics. 2008; 121:e53–e57.

6. Zampieri N, Cervellione RM. Varicocele in adolescents: a 6-year longitudinal and followup observational study. J Urol. 2008; 180:4 Suppl. 1653–1656.

7. Sayfan J, Siplovich L, Koltun L, Benyamin N. Varicocele treatment in pubertal boys prevents testicular growth arrest. J Urol. 1997; 157:1456–1457.

8. Shen JK, Huang GO, Ko EY. Controversies in varicocele repair: much ado about nothing? Asian J Androl. 2016; 18:317–318.

9. Glassberg KI, Korets R. Update on the management of adolescent varicocele. F1000 Med Rep. 2010; 2:25. DOI: 10.3410/M2-25.

10. Mehta A, Goldstein M. Microsurgical varicocelectomy: a review. Asian J Androl. 2013; 15:56–60.

11. Kadyrov ZA, Teodorovich OV, Zokirov OO, Ishonakov KhS, Muminov NO. Bilateral varicocele: epidemiology, clinical presentation and diagnosis. Urologiia. 2007; (3):64–68.

12. Diamond DA, Gargollo PC, Caldamone AA. Current management principles for adolescent varicocele. Fertil Steril. 2011; 96:1294–1298.

13. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970; 21:606–609.

14. Glassberg KI. My indications for treatment of the adolescent varicocele (and why?). Transl Androl Urol. 2014; 3:402–412.

15. Diamond DA, Zurakowski D, Bauer SB, Borer JG, Peters CA, Cilento BG Jr, et al. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents. J Urol. 2007; 178:1584–1588.

16. Masson P, Brannigan RE. The varicocele. Urol Clin North Am. 2014; 41:129–144.

17. Vasavada S, Ross J, Nasrallah P, Kay R. Prepubertal varicoceles. Urology. 1997; 50:774–777.

18. Roque M, Esteves SC. A systematic review of clinical practice guidelines and best practice statements for the diagnosis and management of varicocele in children and adolescents. Asian J Androl. 2016; 18:262–268.

19. Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and testicular function: comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility. Asian J Androl. 2008; 10:319–324.

20. 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; 164:1111–1114.

21. Kurtz MP, Migliozzi M, Rosoklija I, Zurakowski D, Diamond DA. Accuracy of orchidometry in boys with varicocele. J Pediatr Urol. 2015; 11:185.e1–185.e5.

22. Esteves SC, Agarwal A. Afterword to varicocele and male infertility: current concepts and future perspectives. Asian J Androl. 2016; 18:319–322.

23. Coutinho K, McLeod D, Stensland K, Stock JA. Variations in the management of asymptomatic adolescent grade 2 or 3 left varicoceles: a survey of practitioners. J Pediatr Urol. 2014; 10:430–434.

24. Lee TH, Jung JH, Hong YK. Diagnosis and management of pediatric and adolescent varicocele: a survey of pediatric urologists in Korea. Chonnam Med J. 2016; 52:207–211.

25. 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.e1–77.e5.

26. Rajfer J. Varicoceles: practice guidelines. Rev Urol. 2007; 9:161.

27. de Los Reyes T, Locke J, Afshar K. Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes. Can Urol Assoc J. 2017; 11:S34–S39.

28. Tanrikut C, Goldstein M, Rosoff JS, Lee RK, Nelson CJ, Mulhall JP. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011; 108:1480–1484.

29. Trost LW, Mulhall JP. Challenges in testosterone measurement, data interpretation, and methodological appraisal of interventional trials. J Sex Med. 2016; 13:1029–1046.

30. Choi WS, Kim SW. Current issues in varicocele management: a review. World J Mens Health. 2013; 31:12–20.

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; 9:1018–1022.

32. Richter F, Stock JA, LaSalle M, Sadeghi-Nejad H, Hanna MK. Management of prepubertal varicoceles-results of a questionnaire study among pediatric urologists and urologists with infertility training. Urology. 2001; 58:98–102.

33. Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril. 2006; 86:S93–S95.

34. Pastuszak AW, Kumar V, Shah A, Roth DR. Diagnostic and management approaches to pediatric and adolescent varicocele: a survey of pediatric urologists. Urology. 2014; 84:450–455.

35. Decastro GJ, Shabsigh A, Poon SA, Laor L, Glassberg KI. Adolescent varicocelectomy: is the potential for catch-up growth related to age and/or Tanner stage? J Urol. 2009; 181:322–327.

36. Reşorlu B, Kara C, Sahin E, Unsal A. The significance of age on success of surgery for patients with varicocele. Int Urol Nephrol. 2010; 42:351–356.

37. Laven JS, Haans LC, Mali WP, te Velde ER, Wensing CJ, Eimers JM. Effects of varicocele treatment in adolescents: a randomized study. Fertil Steril. 1992; 58:756–762.

38. Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, et al. European Association of Urology guidelines on male infertility: the 2012 update. Eur Urol. 2012; 62:324–332.

39. Bogaert G, Orye C, De Win G. Pubertal screening and treatment for varicocele do not improve chance of paternity as adult. J Urol. 2013; 189:2298–2303.

40. Van Batavia JP, Woldu SL, Raimondi PM, Spencer BA, Insel BJ, Poon SA, et al. Adolescent varicocele: influence of Tanner stage at presentation on the presence, development, worsening and/or improvement of testicular hypotrophy without surgical intervention. J Urol. 2010; 184:4 Suppl. 1727–1732.

41. Paduch DA, Niedzielski J. Repair versus observation in adolescent varicocele: a prospective study. J Urol. 1997; 158:1128–1132.

42. Cayan S, Akbay E, Bozlu M, Doruk E, Erdem E, Acar D, et al. The effect of varicocele repair on testicular volume in children and adolescents with varicocele. J Urol. 2002; 168:731–734.

43. Sathya Srini V, Belur Veerachari S. Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study. Int J Endocrinol. 2011; DOI: 10.1155/2011/916380.

44. Harel M, Herbst KW, Nelson E. Practice patterns in the surgical approach for adolescent varicocelectomy. Springerplus. 2015; 4:772.

45. Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation. J Urol. 1987; 137:475–476.

46. Feber KM, Kass EJ. Varicocelectomy in adolescent boys: long-term experience with the Palomo procedure. J Urol. 2008; 180:4 Suppl. 1657–1659. discussion 1659-60.

47. Sinanoglu O, Eyyupoglu SE, Ekici S. Ipsilateral testicular catch-up growth rate following microsurgical inguinal adolescent varicocelectomy. ScientificWorldJournal. 2012; DOI: 10.1100/2012/356374.

48. Poon SA, Kozakowski KA, Decastro GJ, Gjertson CK, Glassberg KI. Adolescent varicocelectomy: postoperative catch-up growth is not secondary to lymphatic ligation. J Pediatr Urol. 2009; 5:37–41.

49. Fast AM, Deibert CM, Van Batavia JP, Nees SN, Glassberg KI. Adolescent varicocelectomy: does artery sparing influence recurrence rate and/or catch-up growth? Andrology. 2014; 2:159–164.

50. 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; 79:1340–1345.

51. Shiraishi K, Oka S, Matsuyama H. Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele. Int J Urol. 2016; 23:338–342.

52. Atassi O, Kass EJ, Steinert BW. Testicular growth after successful varicocele correction in adolescents: comparison of artery sparing techniques with the Palomo procedure. J Urol. 1995; 153:482–483.

53. Chiba K, Fujisawa M. Clinical outcomes of varicocele repair in infertile men: a review. World J Mens Health. 2016; 34:101–109.

54. Nork JJ, Berger JH, Crain DS, Christman MS. Youth varicocele and varicocele treatment: a meta-analysis of semen outcomes. Fertil Steril. 2014; 102:381–387.e6.

55. Pastuszak AW, Wang R. Varicocele and testicular function. Asian J Androl. 2015; 17:659–667.

56. Pajovic B, Radojevic N. Prospective follow up of fertility after adolescent laparoscopic varicocelectomy. Eur Rev Med Pharmacol Sci. 2013; 17:1060–1063.

57. Kim SO, Jung H, Park K. Outcomes of microsurgical subinguinal varicocelectomy for painful varicoceles. J Androl. 2012; 33:872–875.

58. Park HJ, Lee SS, Park NC. Predictors of pain resolution after varicocelectomy for painful varicocele. Asian J Androl. 2011; 13:754–758.

59. Kim HT, Song PH, Moon KH. Microsurgical ligation for painful varicocele: effectiveness and predictors of pain resolution. Yonsei Med J. 2012; 53:145–150.

60. Park YW, Lee JH. Preoperative predictors of varicocelectomy success in the treatment of testicular pain. World J Mens Health. 2013; 31:58–63.