Incidence of varicocele in children and adolescents: a population-based study on 1200 young Bulgarian males

Abstract

Objective: The incidence of varicocele in the general adult population is approximately 15%. In addition, varicocele is found in about 19% to 41% of men presenting for infertility investigations. However, data are lacking as to the age at which varicocele starts to appear and the overall incidence among younger males. In this study, we examined the incidence of varicocele among 1200 young Bulgarian males. Design: A population-based cross-sectional study. Materials/Methods: The subjects of this study were 1200 healthy boys randomly selected from all socioeconomic classes and districts in Sofia, the capital of Bulgaria. The sample represents, to a great extent, the Bulgarian population as a whole. The subjects were divided according to their age at the time of examination into 3 groups: group 1 (few months after birth to 6 years, n = 420), group 2 (from 7 to 12 years, n = 360) and group 3 (from 13 to 19, n = 420). The same investigator (P.K.) examined all boys. Testicular volume (in mL) was determined using Prader’s orchidometer. Examination for varicocele included scrotal palpation while standing, and Valsalva maneuver for non-palpable varicocele. Results: A left-sided varicocele was found in 67/1200 (5.6%) boys. In group 1, only 1 six years old boy had varicocele (1/420, 0.2%) compared to 22/360 (6.1%) in group 2 and 44/420 (10.5%) in group 3 (P <0.0001). The median (25% & 75% interquartile range) age of boys with varicocele was 14 (12, 18). Logistic regression analysis indicated that the age of the subject was a significant risk factor for diagnosis of varicocele (odds ratio = 1.61 at 95% confidence interval, P <0.0001). Left testicular volume in boys with varicocele <9 (4, 12) mL>was not significantly different from the volume of an age-matched group of boys without varicocele <8 (2, 12) mL>(P = 0.13). Conclusions: This is the first report on the incidence of varicocele in young Bulgarian males. Our study shows that varicocele can be detected as early as the age of 6 years and that its prevalence increases progressively with age. In addition, our study indicates that varicocele had no impact on testicular volume in children and adolescents. Studies are underway to examine spermatogenic function of the testes in boys who have varicocele as they reach puberty. Supported by: None.