Varicocele in the adolescent

Abstract

Varicocele is a dilatation of the veins of the pampiniform plexus caused by reflux within the spermatic venous system. In the majority of cases it becomes apparent during pubertal development. The etiology of varicocele is likely multifactorial. The varicocele may have a negative effect on gonadal growth in the pediatric-adolescent age group and may be associated with a significant reduction in testicular volume and progressive decline in testicular function. The most likely mechanism is an elevation of testicular temperature due to an impaired counter-current heat exchange mechanism. Initial diagnosis is based on the clinical examination, which, in selected cases, may be followed by other non-invasive evaluations: Doppler, color Doppler ultrasound of the spermatic cord (the examination of choice), or ultrasound of the testis. The role of hormonal studies (gonadotropin, testosterone and inhibin B levels) is controversial and analysis of seminal fluid may be difficult to obtain in a minor. This statement offers recommendations regarding the best practice policies for evaluation and treatment of varicocele in adolescents.