Academic Journal
Adolescent varicocele: a surgical conundrum.
| Τίτλος: | Adolescent varicocele: a surgical conundrum. |
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| Συγγραφείς: | Beland LE; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Davis MF; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Aiyar S; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., van Batavia J; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Kolon TF; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Mittal S; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: MittalS3@chop.edu. |
| Πηγή: | Fertility and sterility [Fertil Steril] 2026 Jul; Vol. 126 (1), pp. 17-25. Date of Electronic Publication: 2026 Apr 30. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier for the American Society for Reproductive Medicine Country of Publication: United States NLM ID: 0372772 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-5653 (Electronic) Linking ISSN: 00150282 NLM ISO Abbreviation: Fertil Steril Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York. NY : Elsevier for the American Society for Reproductive Medicine Original Publication: New York, Hoeber. |
| Ιατρικοί όροι (MeSH): | Varicocele*/surgery , Varicocele*/physiopathology , Varicocele*/diagnosis , Varicocele*/epidemiology , Varicocele*/complications , Infertility, Male*/physiopathology , Infertility, Male*/etiology , Infertility, Male*/diagnosis , Infertility, Male*/prevention & control , Infertility, Male*/surgery , Testis*/surgery , Testis*/physiopathology , Urologic Surgical Procedures, Male*/adverse effects , Urologic Surgical Procedures, Male*/methods, Humans ; Male ; Adolescent ; Treatment Outcome ; Spermatogenesis ; Risk Factors ; Fertility ; Age Factors |
| Περίληψη: | Adolescent varicocele is a common yet clinically complex condition, affecting up to 15% of postpubertal boys. The natural history and long-term reproductive implications in adolescents are not as well understood as the association of varicocele with infertility in the adult population. As such, the primary challenge in the management of adolescent varicocele lies in identifying the subset of boys at risk for impaired spermatogenesis while avoiding unnecessary intervention in those who may normalize testicular development as puberty progresses. The pathophysiology of varicocele-related testicular dysfunction is thought to be multifactorial, involving increased scrotal temperature, oxidative stress, and associated germ cell apoptosis. There is also an element of genetic factors that may have implications in the development of varicocele and susceptibility to spermatogenic injury. Regardless of history, we have taken an institutional algorithmic approach whereby boys are evaluated at the time of initial presentation using a longitudinal, biologically informed process incorporating physical exam, serial assessment of total and relative testicular volume, scrotal ultrasound, endocrine evaluation, and semen analysis in appropriate Tanner V patients. Indications for surgical intervention in adolescents are guided by surrogate markers of testicular dysfunction such as persistent testicular volume asymmetry, abnormal semen parameters, and hormonal abnormalities. The preferred technique for intervention when indicated is a subinguinal microsurgical varicocele repair because this is associated with low recurrence and few complications. Surgical repair has been shown to improve testicular growth and semen parameters. However, the long-term impact of surgical repair on paternity is particularly challenging to assess in the adolescent population and requires continued long-term study. An algorithmic, longitudinal approach to the evaluation and management of adolescent varicocele that allows for the early identification of at-risk patients and avoidance of overtreatment is presented. Ultimately, management should be individualized, with the goal of preserving testicular function and optimizing future reproductive potential. (Copyright © 2026 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of Interests L.E.B. has nothing to disclose. M.F.D. has nothing to disclose. S.A. has nothing to disclose. J.v.B. has nothing to disclose. T.F.K. has nothing to disclose. S.M. has nothing to disclose. |
| Contributed Indexing: | Keywords: Adolescent varicocele; male infertility; spermatogenesis; testicular asymmetry; varicocelectomy |
| Entry Date(s): | Date Created: 20260501 Date Completed: 20260623 Latest Revision: 20260623 |
| Update Code: | 20260624 |
| DOI: | 10.1016/j.fertnstert.2026.04.015 |
| PMID: | 42066978 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1556-5653 |
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| DOI: | 10.1016/j.fertnstert.2026.04.015 |