Abstract
Pediatric varicocele has an overall prevalence of 15%, being more frequent as puberty begins. It can damage testicular function, interfering with Sertoli cell proliferation and hormone secretion, testicular growth and spermatogenesis. Proper management has a pivotal role for future fertility preservation. The aim of this review was to discuss the diagnosis, management and treatment of childhood and adolescent varicocele from an endocrinologic perspective, illustrating the current evidence of the European Society of Pediatric Urology (ESPU), the European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) scientific societies. According to the ASRM/ESPU/AUA practice committee, the treatment of adolescent varicocele is indicated in the case of decreased testicular volume or sperm abnormalities, while it is contraindicated in subclinical varicocele. The recent EAS/ESPU meta-analysis reports that moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration increase. No specific phenotype in terms of testicular volume cut-off or peak retrograde flow (PRF) is indicated. Based on current evidence, we suggest that conservative management may be suggested in patients with PRF < 30 cm/s, testicular asymmetry < 10% and no evidence of sperm and hormonal abnormalities. In patients with 10–20% testicular volume asymmetry or 30 < PRF ≤ 38 cm/s or sperm abnormalities, careful follow-up may ensue. In the case of absent catch-up growth or sperm recovery, varicocele repair should be suggested. Finally, treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, PRF > 38 cm/s, infertility and failure of testicular development.
Highlights
Testicular varicocele is defined by the abnormal dilation and tortuosity of the pampiniform plexus draining the testes
Treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, peak retrograde flow (PRF) > 38 cm/s, infertility and failure of testicular development
The aim of this review was to discuss the impact of varicocele on testicular function in childhood and adolescence from an endocrinological perspective and to highlight the best practice in diagnosis, management and treatment, according to the established guidelines by the European Society of Pediatric Urology (ESPU), European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM)
Summary
Testicular varicocele is defined by the abnormal dilation and tortuosity of the pampiniform plexus draining the testes. The prevalence of varicocele is a debated issue since it depends on the selected population (infertile, fertile, age of patients) or the methods used to make the diagnosis (clinical examination and/or Doppler ultrasound). Most of the early epidemiological studies reported that the prevalence of varicocele in the general male adult population is approximately 15%, despite more recent studies suggesting the occurrence of an age-related prevalence or that it is inversely correlated with the body mass index. The prevalence of varicocele seems to differ among fertile and infertile men or in those with primary or secondary infertility [1]. A European study carried out in 7000 young men (median age: 19 years) reported the occurrence of varicocele in 15.7% of cases [2]. In a cohort of 4052 Turkish children and adolescents, its prevalence was 0.8% in
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
