Dilemma of adolescent varicocele: long-term outcome in patients managed surgically and in patients managed expectantly.

OBJECTIVE: To evaluate outcomes of adolescent varicocele in the case of surgical versus conservative management.

METHODS: 173 adolescent patients presenting with varicocele were evaluated clinically and sonographically to define varicocele grade and testicular volume. The patients were divided into 2 groups: A (53) with testicular size discrepancy >20% and bilateral varicoceles; B (120) unilaterally affected patients with testicular size discrepancy <20%, who were randomly allocated into 2 equal sub-groups (B1 & B2) of 60 patients. Group A & B1 patients underwent 3× loupe magnified inguinal varicocelectomy while B2 patients were conservatively managed.

RESULTS: Mean patient age was 14.3 years with mean testicular volume of 11.75 mL and 10.15 mL for right and left testicles, respectively. There were no significant differences between sub-groups B1 & B2 for age, mean testicular volume, size discrepancy and varicocele grade. Mean follow-up of group A & B1 patients was 78 months showing grade I varicocele recurrence (4 cases), catch-up growth in 70% of cases and normal semen analysis in all cases. Mean follow-up of group B2 patients was 79 months showing catch-up growth in 50% of cases and normal semen analysis in all but 1 case. Four cases were shifted to surgical treatment due to reduction of testicular size (2 cases), varicocele upgrade (1 case) and oligoasthenospermia (1 case). At the last follow-up, the mean testicular volume for groups A, B1 & B2 was 16.2, 16.45 & 16.3 mL for right testes and 14.7, 15.6 & 15.2 mL for left testes, respectively. There was significantly better catch-up growth in sub-group B1 compared to B2 but the testicular volume was not statistically different.

CONCLUSIONS: Although adolescent varicocelectomy was associated with a higher percentage of patients showing testicular catch-up growth, the mean testicular volume was not significantly different. Further studies are needed to report on paternity among those patients.