Varicocele

The primary reason to diagnose and treat varicoceles in adolescents is to prevent future infertility. Secondary reasons: 1. Relieve testicular pain. 2. Correct the abnormal appearance of the left scrotum with grade 3 varicoceles. Evidence for these aims: Evidence that treatment of varicoceles in adolescents reduces or prevents adult infertility is lacking. Treatment recommendations currently are based on semen parameters and/or left testicular volume loss, variously described as >2 mL, >10 %, or >20 %. Most adolescents with varicoceles do not have decreased testicular volume compared to controls. Up to 50 % of those with decreased left testicular volume on initial assessment have been reported to have spontaneous improvement within 1-2 years of observation. Up to 33 % of those with initial volume differences <20 % are reported to develop volume discrepancy >20 % within 1-2 years. Relationship between any extent of volume difference between the left and right testis with impaired semen parameters is poorly established in both adolescents and adults with varicoceles. Use of >10 % or >20 % volume discrepancy as an indication for surgery is not based on known infertility risks. There are limited semen analysis data in adolescents with varicoceles, with two studies reporting normal sperm densities but decreased motility and normal morphology, and one reporting decreased sperm density but normal motility and morphology. Our review found only a single study involving 33 adolescents with preoperative and postoperative semen analysis that indicated improved sperm density and motility. Three retrospective studies reported pain relief from varicocelectomy in from 68 to 97 %. One retrospective study stated that 87 % of teens had resolution of the scrotal mass with varicocelectomy.