Treatment of Adolescent and Pediatric Varicocele - Continues to be A Dilemma-A Mini Review

A Varicocele, defined as an abnormal dilation of the pampiniform plexus of veins in the scrotum. This begins at puberty in roughly 15% of males. Though common in the general population, it is often asymptomatic, varicoceles are commonly associated with gonadal dysfunction, that includes testicular atrophy, infertility, and hypogonadism in a subgroup of men diagnosed later in life. In view of high prevalence and uncertain pathogenesis, definitive guidelines for varicoceles diagnosed in the pediatric and adolescent population remain poorly defined. Varicoceles are the most common etiology of male factor infertility and improve fecundity in adulthood. Examination of the pediatric and adolescent varicoceles needs to include history, physical exam, and measurement of testicular volume with orchidometer or ultrasound. Testicular volume differentials and peak retrograde flow varicoceles populations. Semen analysis (SA) and reproductive endocrine parameters assessment should also be considered as part of workup of adolescent patients. Different treatment apptoaches exist for varicocele and although microsurgical subinguinal approaches is considered the gold standard for adult population, it has not been confirmed to be superior for adolescent population. Referral to an andrologist for the adolescent patient with varicocele should be considered in equivocal cases. Though active treatment remains a concern it is clear that some unrelated patients will suffer symptoms later in life, while ovetreatment remains a concern for this large, vulnerable population. Hence surveillance strategies along with improved accuracy in diagnosis of clinically important pediatric varicoceles prompting treatment are required in future.

Keywords: adolescent varicocele, fertility, pediatric varicocele, surgery, observation.