The Adolescent Varicocele

Abstract

Just as all adolescent males should be educated by their primary care physicians about testicular self-examination and the symptoms of testicular torsion, they should also be routinely examined in the upright position. In this issue of Pediatrics , Salzhauer et al1 report the potential advantages of the early recognition and treatment of the adolescent varicocele. The observation that varicoceles affect ipsilateral testicular growth and that this growth arrest can be reversed reportedly dates back to Bennett in an article in The Lancet in 1889. However, this information was apparently lost, and it was not until 1977, when Lipschultz and Corriere2 noted progressive ipsilateral testicular volume loss in adults with varicoceles, that attention became refocused on this problem. Based on their report and the fortuitous observation in an adolescent patient with a varicocele of a significantly smaller left testis as compared with the right, Kass and Belman3 prospectively compared testicular size before and after varicocele ligation. Testicular “catch-up” growth occurred in 80% postoperatively. Subsequently, as noted in the article by Salzhauer et al,1 this has been repeatedly substantiated. However, satisfactory evidence that fertility is improved … Address correspondence to A. Barry Belman, MD, MS, 111 Michigan Ave NW, Washington, DC 20010. E-mail: abbelman{at}cnmc.org