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| Varicocele in Adolescent Boys | ||
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The management of varicocele, a common condition with an estimated incidence of 15% in adolescent boys, is rarely straightforward and is really quite controversial. The boys and their parents are often anxious, confused, and between themselves, may have very different goals and concerns. Fortunately, with education and counseling, a suitable management plan usually can be made. Being fully informed requires discussion of known facts, and perhaps more important, discussion of unanswered questions and existing controversies about this condition. There is an accepted grading schema. Grade I varicoceles are only noticeable during Valsalva maneuver by palpation or by ultrasonography. Grade II varicoceles are easily palpable but not visible during physical examination. Grade III varicoceles are visible to the examiner. In adult men with Grade III varicoceles and infertility (or sub-fertility), surgical data are strongly positive for improvement of semen quantitative and qualitative parameters, and higher pregnancy and birth rates after ligation of spermatic veins. These important supportive data are not available from studies of varicocele in adolescent boys. For this age group, functional data (semen analysis and fertility rate) are practically impossible to obtain. What are available include data of testicular size (or testicular size discrepancy), data of the presence or absence of testicular growth arrest, and data of reversal of testicular growth arrest following spermatic vein ligation. Currently, the most-widely reported indication for surgical correction of varicoceles during adolescence is high-grade varicocele with hypotrophy of the affected testis. Severe (grade III) varicoceles are presumed to be more injurious to the testis, and therefore, potentially more likely to cause growth arrest and impairment of testicular function. Is this fact or just mere assumption? Recent retrospective analysis from Children’s Hospital Boston showed that varicocele grade does not correlate with presence or severity of testicular size disproportion. If this true, then varicocele grade and testicular volume differential may very well be independent variables. In addition, it is possible that there are unidentified factors that may influence testicular growth in adolescents with varicoceles. Rarely straightforward and really quite controversial? I think so. But, a suitable management plan usually can be made. For the group that favors observation, it is comforting to know that most varicoceles in healthy adolescents and adults are obviously not causing significant problems in terms of fertility or pain. For the group that favors treatment, it is comforting to know that most surgical cases do really well with no harm, and may help testicular growth and preserves fertility potential. Robert Q. Hoang, M.D., F.A.C.S. * This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information. |
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