Adolescent varicocele.
Currently, we recommend varicocele repair in adolescents when (1) the results of semen analysis are abnormal, (2) the volume of the left testis is at least 3 mL less than that of the right, (3) the response of either luteinizing hormone or FSH to Gn-RH stimulation is supranormal, (4) bilaterally palpable varicoceles are detected, or (5) a large symptomatic varicocele is present. When surgery is necessary, the Palomo approach significantly decreases the risk of operative failure and has facilitated "catch-up" growth of the left testis that is comparable to that after artery-sparing procedures. It is important to note that there is potential for impaired fertility whenever a palpable varicocele is present. Unfortunately, no test or group of tests can predict with absolute certainty whether an adolescent with a varicocele will be fertile or infertile. Therefore, it is important to observe untreated patients until they complete their families. Patients who are unwilling or unable to adhere to the follow-up protocol may be candidates for surgical intervention.
Division of Pediatric Urology, William Beaumont Hospital, Royal Oak, Michigan.
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Kass
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Reitelman
D000293:Adolescent; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012661:Semen; D013737:Testis / Q000473:pathology; D014646:Varicocele / Q000150:complications / Q000175:diagnosis / Q000601:surgery