Varicocele

Abstract

Scrotal varicocele is a common finding in adolescent boys and a common reason for referral to the pediatric urologist. While uncommon in prepubertal boys, the prevalence of varicocele increases during adolescence to approach the ~15% incidence rate noted in adult men. In fact, population studies have estimated the incidence of adolescent varicocele to be between 8% and 16%, with one large screening study reporting an incidence of 29% in boys aged 10-16 years old. While an asymptomatic varicocele may seem to be of little to no concern, the fact that 20% of men with varicoceles have problems with fertility is concerning, but predicting which adolescents will become part of this 20% is complex. The use of semen analysis offers an objective way to assess patients with varicoceles, but an “abnormal” semen analysis (SA) does not guarantee infertility in much the same way that a normal SA does not guarantee fertility. Furthermore, obtaining SA in adolescents can be difficult. Therefore, surrogate indications for varicocele repair have been suggested over the previous couple of decades to help guide the pediatric surgeon/urologist in management. If varicocele repair is indicated and the patient and family decide to proceed, there are several procedures and techniques available to the surgeon including surgical repair via retroperitoneal approach, inguinal approach, subinguinal microscopy, laparoscopy, and nonsurgical techniques such as percutaneous sclerotherapy and angiography with embolization. Regardless of the technique used, the ultimate goal of varicocele correction is future paternity, which unfortunately is difficult to study and not often commented upon in the literature.