Varicocele in Adolescents Workup

  • Author: James M Elmore, MD; Chief Editor: Marc Cendron, MD   more...
 
Updated: Jan 11, 2012
 

Laboratory Studies

  • No specific laboratory studies have proven useful in the evaluation of an adolescent with a varicocele. Levels of basal serum testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) are not altered in the patient with varicocele.
  • Gonadotropin-releasing hormone (GnRH) stimulation tests are advocated at some centers. Adolescents at Tanner stage 4 and 5 with large varicoceles tend to have an exaggerated LH and FSH response to GnRH administration, but this is not a consistent finding. Some authors believe that this represents early testicular dysfunction and is an indication for surgical repair, although this has not been prospectively studied.
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Imaging Studies

  • Accurate assessment of testicular volume is important to determine indications for surgical intervention. In the assessment of testicular volume, ultrasonography is generally felt to be superior to orchidometer measurement. The testis is imaged in 3 dimensions, and the volume is calculated using the formula for an ellipse (volume = length X width X depth X 0.53).
  • Upright Doppler ultrasonography with and without Valsalva maneuver may be used in cases in which a varicocele is suspected but not confirmed with physical examination findings, such as in an adolescent who is obese. Doppler ultrasonography may also reveal a small contralateral varicocele.
  • CT scanning is rarely indicated but may exclude an obstructive etiology for an isolated right-sided varicocele or one that does not diminish with the patient supine. Potential findings include a renal or other retroperitoneal mass or thrombosis of the inferior vena cava.
  • Venography is the study of choice to detect a subclinical varicocele in the evaluation of infertile adult patients but has a limited role in adolescents. Teenagers with unexplained testicular atrophy or scrotal pain may be evaluated with venography but only if findings on an upright scrotal ultrasound with Doppler flow measurements during Valsalva maneuver are nondiagnostic.
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Other Tests

  • Although not routinely performed in adolescents, a semen analysis in older teenagers may be appropriate as abnormal results may influence management decisions. However, one sperm count may not always be considered reliable and normal sperm count parameters have not been published for adolescents.
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Diagnostic Procedures

  • No procedures are used in the evaluation of varicoceles in adolescents.
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Histologic Findings

  • Testicular biopsy to assess any damage to the testicle is not routinely performed.
  • Presently, available data provide no specific histologic criteria for predicting the reversibility of changes or the impact on fertility.
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Contributor Information and Disclosures
Author

James M Elmore, MD  Clinical Assistant Professor, Department of Urology, Division of Pediatric Urology, Emory University/Children's Healthcare of Atlanta

James M Elmore, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew J Kirsch, MD, FAAP, FACS  Clinical Professor of Urology, Emory University School of Medicine, Children's Healthcare of Atlanta; President, Georgia Urology, PA

Andrew J Kirsch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Society for Fetal Urology

Disclosure: QMED Grant/research funds Investigation, Consulting; COOK Urological Royalty Consulting

Joseph Ortenberg, MD  Clinical Professor of Urology and Pediatrics, Louisiana State University School of Medicine, New Orleans; Director of Urologic Education, Children's Hospital, New Orleans;

Joseph Ortenberg, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Society of University Urologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Bartley G Cilento, Jr, MD  Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School

Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Harry P Koo, MD  Chairman of Urology Division and Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Marc Cendron, MD  Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

References

  1. Hadziselimovic F, Herzog B, Jenny P. The chance for fertility in adolescent boys after corrective surgery for varicocele. J Urol. Aug 1995;154(2 Pt 2):731-3. [Medline].

  2. Steeno OP. Varicocele in the adolescent. Adv Exp Med Biol. 1991;286:295-321. [Medline].

  3. Lyon RP, Marshall S, Scott MP. Varicocele in youth. West J Med. Jun 1983;138(6):832-4. [Medline].

  4. Hawkins CM, Racadio JM, McKinney DN, Racadio JM, Vu DN. Varicocele Retrograde Embolization with Boiling Contrast Medium and Gelatin Sponges in Adolescent Subjects: A Clinically Effective Therapeutic Alternative. J Vasc Interv Radiol. Dec 14 2011;[Medline].

  5. Diamond DA, Gargollo PC, Caldamone AA. Current management principles for adolescent varicocele. Fertil Steril. Dec 2011;96(6):1294-8. [Medline].

  6. Nees SN, Glassberg KI. Observations on hydroceles following adolescent varicocelectomy. J Urol. Dec 2011;186(6):2402-7. [Medline].

  7. Wein AJ, Kavoussi LR, Novick AC, et al. Campbell-Walsh Urology. 3rd ed. Saunders; 2007:560.

  8. Kass EJ, Belman AB. Reversal of testicular growth failure by varicocele ligation. J Urol. Mar 1987;137(3):475-6. [Medline].

  9. Lipshultz L, Jarow JP. Varicocele and male subfertility. In: Speroff J, Sciarra JJ. Gynecology and Obstetrics. Philadelphia, Pa: JB Lippincott; 1989:1-12.

  10. Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. Mar 2007;69(3):417-20. [Medline].

  11. Atassi O, Kass EJ, Steinert BW. Testicular growth after successful varicocele correction in adolescents: comparison of artery sparing techniques with the Palomo procedure. J Urol. Feb 1995;153(2):482-3. [Medline].

  12. Belloli G, D'Agostino S, Musi L, Campobasso P. Adolescent varicocele: operative anatomy and tricks for successful correction. Eur J Pediatr Surg. Aug 1995;5(4):219-21. [Medline].

  13. Buch JP, Cromie WJ. Evaluation and treatment of the preadolescent varicocele. Urol Clin North Am. Feb 1985;12(1):3-12. [Medline].

  14. Costabile RA, Skoog S, Radowich M. Testicular volume assessment in the adolescent with a varicocele. J Urol. May 1992;147(5):1348-50. [Medline].

  15. Gershbein AB, Horowitz M, Glassberg KI. The adolescent varicocele I: left testicular hypertrophy following varicocelectomy. J Urol. Oct 1999;162(4):1447-9. [Medline].

  16. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. Mar 1993;59(3):613-6. [Medline].

  17. Haans LC, Laven JS, Mali WP, et al. Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varicocele. Fertil Steril. Oct 1991;56(4):731-6. [Medline].

  18. Hassan JM, Adams MC, Pope JC, et al. Hydrocele formation following laparoscopic varicocelectomy. J Urol. Mar 2006;175(3 Pt 1):1076-9. [Medline].

  19. Iselin CE, Almagbaly U, Borst F, et al. Safety and efficiency of laparoscopic varicocelectomy in one hundred consecutive cases. Urol Int. 1997;58(4):213-7. [Medline].

  20. Kass EJ. The adolescent varicocele: treatment and outcome. Curr Urol Rep. Apr 2002;3(2):100-6. [Medline].

  21. Kass EJ, Freitas JE, Bour JB. Adolescent varicocele: objective indications for treatment. J Urol. Aug 1989;142(2 Pt 2):579-82; discussion 603-5. [Medline].

  22. Kass EJ, Marcol B. Results of varicocele surgery in adolescents: a comparison of techniques. J Urol. Aug 1992;148(2 Pt 2):694-6. [Medline].

  23. Laven JS, Haans LC, Mali WP, et al. Effects of varicocele treatment in adolescents: a randomized study. Fertil Steril. Oct 1992;58(4):756-62. [Medline].

  24. Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsurgical repair of the adolescent varicocele. J Urol. Jul 1998;160(1):179-81. [Medline].

  25. Lenzi A, Gandini L, Bagolan P, et al. Sperm parameters after early left varicocele treatment. Fertil Steril. Feb 1998;69(2):347-9. [Medline].

  26. Lund L, Tang YC, Roebuck D, et al. Testicular catch-up growth after varicocele correction in adolescents. Pediatr Surg Int. 1999;15(3-4):234-7. [Medline].

  27. Paduch DA, Niedzielski J. Repair versus observation in adolescent varicocele: a prospective study. J Urol. Sep 1997;158(3 Pt 2):1128-32. [Medline].

  28. Paduch DA, Niedzielski J. Semen analysis in young men with varicocele: preliminary study. J Urol. Aug 1996;156(2 Pt 2):788-90. [Medline].

  29. Parrott TS, Hewatt L. Ligation of the testicular artery and vein in adolescent varicocele. J Urol. Aug 1994;152(2 Pt 2):791-3; discussion 793. [Medline].

  30. Pini Prato A, MacKinlay GA. Is the laparoscopic Palomo procedure for pediatric varicocele safe and effective? Nine years of unicentric experience. Surg Endosc. Apr 2006;20(4):660-4. [Medline].

  31. Pinto KJ, Kroovand RL, Jarow JP. Varicocele related testicular atrophy and its predictive effect upon fertility. J Urol. Aug 1994;152(2 Pt 2):788-90. [Medline].

  32. Podesta ML, Gottlieb S, Medel R Jr, et al. Hormonal parameters and testicular volume in children and adolescents with unilateral varicocele: preoperative and postoperative findings. J Urol. Aug 1994;152(2 Pt 2):794-7; discussion 798. [Medline].

  33. Preston MA, Carnat T, Flood T, Gaboury I, Leonard MP. Conservative management of adolescent varicoceles: a retrospective review. Urology. Jul 2008;72(1):77-80. [Medline].

  34. Reyes BL, Trerotola SO, Venbrux AC, et al. Percutaneous embolotherapy of adolescent varicocele: results and long-term follow-up. J Vasc Interv Radiol. Jan-Feb 1994;5(1):131-4. [Medline].

  35. Sayfan J, Siplovich L, Koltun L, Benyamin N. Varicocele treatment in pubertal boys prevents testicular growth arrest. J Urol. Apr 1997;157(4):1456-7. [Medline].

  36. Sigman M, Jarow JP. Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. J Urol. Aug 1997;158(2):605-7. [Medline].

  37. Skoog SJ, Roberts KP, Goldstein M, Pryor JL. The adolescent varicocele: what's new with an old problem in young patients?. Pediatrics. Jul 1997;100(1):112-21. [Medline].

 
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Table 1. Average Male Testis Volume at Different Stages of Development, as Determined by Orchidometer[1]
Tanner StageLeft TestisRight Testis
14.76 ±2.76 cm35.20 ±3.86 cm3
26.40 ±3.16 cm37.08 ±3.89 cm3
314.58 ±6.54 cm314.77 ±6.1 cm3
419.80 ±6.17 cm320.45 ±6.79 cm3
528.31 ±8.52 cm330.25 ±9.64 cm3
Table 2. Postoperative Complication Rates[7]
TechniqueHydroceleRecurrence or Failure
Open inguinal/sublingual3-9%15% average
Microscopic inguinal/sublingual< 1%1-3%
Retroperitoneal mass ligation7.2%2%
Retroperitoneal artery sparing< 7.2%11%
LaparoscopicSimilar to openSimilar to open
EmbolizationNone10-25%
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