TY - JOUR
T1 - The varicocele
T2 - Diagnostic dilemmas, therapeutic challenges and future perspectives
AU - Chiba, Koji
AU - Ramasamy, Ranjith
AU - Lamb, Dolores J.
AU - Lipshultz, Larry
N1 - Funding Information:
RR is a K12 scholar supported by a Male Reproductive Health Research (MRHR) Career Development Physician‑Scientist Award (Grant # HD073917‑01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program to DJL. DJL is supported in part by R01DK078121 from National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (to DJL).
Funding Information:
RR is a K12 scholar supported by a Male Reproductive Health Research (MRHR) Career Development Physician?Scientist Award (Grant # HD073917?01) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Program to DJL. DJL is supported in part by R01DK078121 from National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (to DJL).
Publisher Copyright:
© 2016 AJA, SIMM & SJTU.
PY - 2016/3
Y1 - 2016/3
N2 - 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.
AB - 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.
KW - adolescent
KW - adult
KW - management
KW - varicocele
UR - http://www.scopus.com/inward/record.url?scp=84957867956&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84957867956&partnerID=8YFLogxK
U2 - 10.4103/1008-682X.167724
DO - 10.4103/1008-682X.167724
M3 - Review article
C2 - 26698233
AN - SCOPUS:84957867956
VL - 18
SP - 276
EP - 281
JO - Asian Journal of Andrology
JF - Asian Journal of Andrology
SN - 1008-682X
IS - 2
ER -