Varicocele in adolescents.

Abstract

Varicocele is the condition of abnormal venous dilatation of the pampiniform venous system presented at the upper pole of the testicle, sometimes associated with intratesticular varices. Dominantly presented on the left testicle, it is rarely noted on the right one or bilaterally. According to one interpretation, higher incidence in puberty can be accounted for by testicular blood flow increase in the testicular veins. Whatever the primary etiological factor may be, venous hypertension in the venous cord due to renospermatic venous reflux is a constant feature and is responsible for different pathological changes which occur in both the cord veins and the testicle. Vein congestion and heat exchange disturb and increase scrotal temperature having a negative effect on spermatogenesis and also induce irregular apoptosis in germ cells. Recently, reactive oxygen species production in association with decreased antioxidant capacity have been put under suspicion of deteriorating spermatogenesis. Varicoceles in adolescents are usually asymptomatic and the diagnosis is most frequently made according to the typical appearance by the routine annual school physical examination. Ultrasonography and Doppler mode are the most practical and non- invasive examinations. Semen analysis is possible three years after the onset of puberty when semen parameters reach adult values. Deterioration of spermatogenesis and infertility in adults could be accepted as a distant complication of adolescent varicocele. Many agree that indications for surgical intervention in adolescent are: pain, large varicoceles, hypotrophy of the involved testicle, bilateral varicocele, intratesticular varicocele and patients with abnormal semen parameters on serial evaluation. The ideal method for treating adolescent varicocele still remains controversial, but the main task is to decrease the number of recurrences and complications, while retaining optimum testicular function. Because of that, many surgeons respect the attitude "catch up growth".