The varicocele: Diagnostic dilemmas, therapeutic challenges and future perspectives

Koji Chiba, Ranjith Ramasamy, Dolores J. Lamb, Larry Lipshultz

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not obtained from the adolescent male, in the absence of other symptoms, the main clinical indication used by many urologists to recommend repair is testicular atrophy. The varicocele may result in testicular damage in some males causing testicular atrophy with impaired sperm production and decreased Leydig cell function, while in other males the varicocele may seemingly cause no ill effects. In adult men, varicoceles are frequently present and surgically correctable, yet the measurable benefits of surgical repair are slight according to a Cochrane review. While occurring more commonly in infertile men than fertile men, only 20% of men with a documented varicocele will suffer from fertility problems. Most varicoceles found in adolescents are detected during a routine medical examination, and it is difficult to predict which adolescent presenting with a varicocele will ultimately show diminished testicular function in adolescence or adulthood. As in adults, the mainstay of treatment for varicocele in adolescents is surgical correction. However, unlike an adult varicocelectomy (the microsurgical approach is the most common), treatment for an adolescent varicocele is more often laparoscopic. Nevertheless, the goals of treatment are the same in the adolescent and adult patients. Controversy remains as to which patients to treat, when to initiate the treatment, and what type of treatment is the best. This review will present the current understanding of the etiology, diagnosis and treatment of the adolescent varicocele.

Original languageEnglish (US)
Pages (from-to)276-281
Number of pages6
JournalAsian Journal of Andrology
Volume18
Issue number2
DOIs
StatePublished - Mar 2016

Keywords

  • adolescent
  • adult
  • management
  • varicocele

ASJC Scopus subject areas

  • Urology

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