From the Guidelines
For a 16-year-old with a varicocele, treatment should be considered if the varicocele is causing pain, testicular atrophy, or abnormal semen parameters, with microsurgical varicocelectomy being the preferred surgical approach, as it has the lowest recurrence and complication rates, according to the most recent evidence available 1. When considering treatment for a varicocele in a 16-year-old, it is essential to evaluate the symptoms and severity of the condition.
- If the varicocele is asymptomatic and not causing testicular size discrepancy, observation with annual follow-up is appropriate to monitor for development of pain or testicular growth issues.
- Non-surgical management includes scrotal support, anti-inflammatory medications like ibuprofen (400-600mg every 6-8 hours as needed), and cold compresses for symptomatic relief.
- Treatment is crucial because varicoceles can potentially affect fertility by increasing testicular temperature and causing oxidative stress, which may impair sperm production and function, as highlighted in the study by Shridharani et al., (2016) 1. The importance of early intervention in adolescents with testicular growth issues cannot be overstated, as it may help preserve future fertility potential, and the treating physician’s experience and expertise, including evaluation of both partners, together with the options available, should determine the approach to varicocele treatment, as suggested by the Practice Committee of the ASRM; Society for Male Reproduction and Urology (2014) 1.
- Endovascular therapy, such as gonadal vein embolization, is also an effective option for relieving orchialgia, with studies showing that it can provide complete pain relief in up to 87% of patients 1. It is vital to note that the treatment approach should be individualized, taking into account the patient's specific needs and circumstances, and that further research is necessary to guide clinical management, as emphasized by the analysis of the EAU, ASRM, and AUA recommendations on varicocele 1.
From the Research
Treatment Options for Varicocele
- Surgical correction is the mainstay of treatment for varicocele in adolescents, with laparoscopic treatment being more common in this age group 2
- Percutaneous embolization of the internal spermatic vein is another option, offering a rapid recovery but requiring interventional radiologic expertise and carrying potential serious complications 3
- Microsurgical subinguinal and laparoscopic lymphatic sparing techniques have shown the best results in treating varicocele, as demonstrated in a meta-analysis 4
Indications for Treatment
- Testicular atrophy, pain, and peak retrograde flow (PRF) are indicators for varicocelectomy in adolescents 4, 5
- A persistent discrepancy between left and right testis size of more than 20% over a period of 12 months is a good indication for treatment 4
- PRF = 38 cm/s in combination with testicular asymmetry = 20% is a reason for surgery, independent of age, Tanner stage, or varicocele size 4
Diagnostic Evaluation
- History, physical exam, and measurement of testicular volume with orchidometer or ultrasound are essential in evaluating pediatric and adolescent varicocele 5
- Testicular volume differentials and peak retrograde flow on Doppler ultrasonography are important factors in risk stratification of the pediatric varicocele population 5
- Semen analysis and reproductive endocrine assessment should also be considered as part of the workup for adolescent patients 5
Management and Follow-up
- Adolescents with varicocele need regular follow-up, including clinical examination and ultrasound measurements of the testis 4
- Patients suitable for conservative management should be followed until semen analysis is possible 4
- A flow-chart can be used to guide the management of adolescent varicocele, taking into account factors such as testicular asymmetry, PRF, and patient age 4