The adolescent varicocele: Treatment and outcome

Current Urology Reports

Volumn 3, Issue 2, 2002, Pages 100-106

  Kass, Evan J ^a  

^a WILLIAM BEAUMONT HOSPITAL   (United States)

Author keywords

Internal Spermatic Vein; Left Testis; Testicular Biopsy; Testicular Volume; Varicocele

Indexed keywords

GONADOTROPIN;

CONGENITAL MALFORMATION; GROWTH, DEVELOPMENT AND AGING; HUMAN; MALE; PHYSIOLOGY; REVIEW; SPERMATOZOON; TESTIS; VARICOCELE;

GONADOTROPINS; HUMANS; MALE; SPERMATOZOA; TESTIS; VARICOCELE;

EID: 0036549857     PISSN: 15272737     EISSN: 15346285     Source Type: Journal    
DOI: 10.1007/s11934-002-0019-2     Document Type: Article

References (45)

1. Nasu T, Takihara H, Hirayama A: A new apparatus for the measurement of testicular volume. Jpn J Fertil Steril 1979, 24:12.
2. Costabile RA, Skoog S, Radowich M: Testicular volume assessment in the adolescent with a varicocele. J Urol 1992, 147:1348–1350.
3. Behre HM, Nashan D, Nieschlag E: Objective measurement of testicular volume by ultrasonography: evaluation of the technique and comparison with orchidometer estimates. Int J Androl 1989, 12:395–403.
4. Cockett ATK, Takihara H, Cosentino MJ: The varicocele. Fertil Steril 1984, 41:5–11.
5. Steeno O, Knops J, Declerck L, et al.: Prevention of fertility disorders by detection and treatment of varicocele at school and college age. Andrologia 1976, 8:47–53. DOI: 10.1111/j.1439-0272.1976.tb01645.x
6. Lipshultz LI, Corriere JN Jr: Progressive testicular atrophy in the varicocele patient. J Urol 1977, 117:175–176.
7. Lyon RP, Marshall S, Scott MP: Varicocele in childhood and adolescence: implication in adulthood infertility? Urology 1982, 19:641–644. DOI: 10.1016/0090-4295(82)90019-X
8. Kass EJ, Stork BR, Steinert BW: Varicocele in adolescence induces left and right testicular volume loss. BJU Int 2001, 87:1–4. The presence of a grade I varicocele in adolescents appears to have no effect on normal testicular growth. Some patients with a grade II varicocele are at risk of left-testicular volume loss with time and should have their testicular volumes measured annually. Patients with grade III varicoceles are at risk for bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended for this group of patients. DOI: 10.1046/j.1464-410X.2001.00144.x
9. Kass EJ, Belman AB: Reversal of testicular growth failure by varicocele ligation. J Urol 1987, 137:475–476.
10. Agger P, Johnsen SG: Quantitative evaluation of testicular biopsies in varicocele. Fertil Steril 1978, 29:52–57.
11. Charney CW: Effect of varicocele on fertility—results of varicocelectomy. Fertil Steril 1962, 13:47.
12. Ibrahim AA, Awad HA, El-Haggar S, Mitawi BA: Bilateral testicular biopsy in men with varicocele. Fertil Steril 1977, 28:663–667.
13. McFadden MR, Mehan DJ: Testicular biopsies in 101 cases of varicocele. J Urol 1978, 119:372–374.
14. Hadziselimovic F, Leibundgut B, Da Rugna D, Buser MW: The value of testicular biopsy in patients with varicocele. J Urol 1986, 135:707–710.
15. Cameron DF, Snydle FE, Ross MH, et al.: Ultrastructural alternations in the adluminal testicular compartment in men with varicocele. Fertil Steril 1980, 33:526–533.
16. Johnsen SG, Agger P: Quantitative evaluation of testicular biopsies before and after operation for varicocele. Fertil Steril 1978, 29:58–63.
17. Hienz HA, Voggenthaler J, Weissbach L: Histological findings in testes with varicocele during childhood and their therapeutic consequences. Eur J Pediatr 1980, 133:139–146. DOI: 10.1007/BF00441582
18. Kass EJ, Chandra RS, Belman AB: Testicular histology in the adolescent with a varicocele. Pediatrics 1987, 79:996–998.
19. Hadziselimovic F, Herzog B, Liebundgut B, et al.: Testicular and vascular changes in children and adults with varicocele. J Urol 1989, 142:583–585.
20. Kay R, Alexander NJ, Baugham WL: Induced varicocele in rhesus monkeys. Fertil Steril 1979, 31:195–199.
21. Saypol DC, Howards SS, Turner TT, Miller ED Jr: Influence of surgically induced varicocele on testicular blood flow, temperature, and histology in adult rats and dogs. J Clin Invest 1981, 68:39–45. DOI: 10.1172/JCI110252
22. Green KF, Turner TT, Howards SS: Varicocele: reversal of the testicular blood flow and temperature effects by varicocele repair. J Urol 1984, 131:1208–1211.
23. Dandia SD, Bagree SD, Vyas CP, et al.: Experimental production of varicocele and its effect on testes. Jpn J Surg 1979, 9:372–378. DOI: 10.1007/BF02468639
24. Fussell EN, Lewis RW, Roberts JA, et al.: Early ultrastructural findings in experimentally produced varicocele in the monkey testis. J Androl 1981, 2:111.
25. Ospina LF: Augmented gonadotropin response to luteinizing hormone-releasing hormone (LH-RH) in infertile men with varicocele [abstract]. Clin Res 1977, 25:106.
26. Hudson RW, Perez-Marrero RA, Crawford VA, McKay DE: Hormonal parameters in incidental varicoceles and those causing infertility. Fertil Steril 1986, 45:692–700.
27. Hudson RW, Perez-Marrero RA, Crawford VA, McKay DE: Hormonal parameters of men with varicoceles before and after varicocelectomy. Fertil Steril 1985, 43:905–910.
28. Nagao RR, Plymate SR, Berger RE, et al.: Comparison of gonadal function between fertile and infertile men with varicoceles. Fertil Steril 1986, 46:930–933.
29. Dickerman Z, Landman J, Prager-Lewin R, et al.: Evaluation of testicular function in prepubertal boys by means of the luteinizing hormone-releasing hormone test. Fertil Steril 1978, 29:655–660.
30. Lipshultz LI, Caminos-Torres R, Greenspan CS, Snyder PJ: Testicular function after orchiopexy for unilaterally undescended testis. N Engl J Med 1976, 295:15–18. DOI: 10.1056/NEJM197607012950104
31. Okuyama A, Koide T, Itatani H, et al.: Pituitary-gonadal function in schoolboys with varicocele and indications of varicocelectomy. Eur Urol 1981, 7:92–96.
32. Kass EJ, Freitas JE, Salisz JA, Steinert BW: Pituitary gonadal dysfunction in adolescents with varicocele. Urology 1993, 42:179–181. DOI: 10.1016/0090-4295(93)90643-O
33. Janczewski Z, Bablok L: Semen characteristics in pubertal boys. I. Semen quality after first ejaculation. Arch Androl 1985, 15:199–205. Semen specimens from 134 boys were examined. Semen parameters reach published adult normal values 29 to 33 months after the first clinical indications of puberty.
34. Chehval MJ, Purcell MH: Deterioration of semen parameters over time in men with untreated varicocele: evidence of progressive testicular damage. Fertil Steril 1992, 57:174–177. In men with a varicocele, even normal semen parameters may deteriorate over time.
35. Gorelick JI, Goldstein M: Loss of fertility in men with varicocele. Fertil Steril 1993,59:613–616. The incidence of varicocele is much higher in male-factor secondary infertility than in primary infertility. These findings suggest that a varicocele causes a progressive decline in fertility, and prior fertility in men with a varicocele does not predict resistance to varicoceleinduced impairment of spermatogenesis. Men with a varicocele may benefit from early evaluation and prophylactic varicocelectomy to prevent future infertility.
36. Witt MA, Lipshultz LI: Varicocele: a progressive or static lesion? Urology 1993, 42:541–543. DOI: 10.1016/0090-4295(93)90268-F
37. Porst H, Bahren W, Lenz M, Altwein JE: Percutaneous sclerotherapy of varicoceles—an alternative to conventional surgical methods. Br J Urol 1984, 56:73–78. DOI: 10.1111/j.1464-410X.1984.tb07168.x
38. Kaufman SL, Kadir S, Barth KH, et al.: Mechanisms of recurrent varicocele after balloon occlusion of surgical ligation of the internal spermatic vein. Radiology 1983, 147:435–440.
39. Kass EJ, Marcol B: Results of varicocele surgery in adolescents: a comparison of techniques. J Urol 1992, 148:694–696.
40. Wosnitzer M, Roth JA: Optical magnification and Doppler ultrasound probe for varicocelectomy. Urology 1983, 22:24–26. DOI: 10.1016/0090-4295(83)90339-4
41. Palomo A: Radical cure of varicocele by a new technique: preliminary report. J Urol 1949, 61:604.
42. Atassi O, Kass EJ: Testicular growth following successful varicocele correction in adolescents: comparison of artery sparing techniques with the Palomo procedure [abstract]. J Urol 1994, 151:274. We conclude that reversal of varix-induced testicular growth failure occurs only after successful surgical correction. The Palomo procedure resulted in testicular growth equivalent to artery-sparing techniques with fewer complications and no testicular atrophy, despite intentional ligation of the testicular artery. Based on our data, we believe that the Palomo procedure should be the procedure of choice for correction of an adolescent varicocele.
43. Hosli PO: Varicocele—results after early treatment in children and adolescents [in German]. Z Kinderchir 1988, 43:213–215.
44. Okuyama A, Nakamura M, Namiki M, et al.: Surgical repair of varicocele at puberty: preventive treatment for fertility improvement. J Urol 1988, 139:562–564.
45. Lemack G, Uzzo R, Schlegel P, Goldstein M: Microsurgical repair of the adolescent varicocele. J Urol 1998, 160:179–181. The meticulous dissection necessary to preserve arterial and lymphatic supply and to ligate all spermatic veins in the pediatric patient is readily accomplished using a microsurgical approach and results in low recurrence and complication rates. Rapid catch-up growth of the affected testis after microsurgical varicocelectomy suggests that intervention during adolescence is effective and warranted. DOI: 10.1016/S0022-5347(01)63086-6