title: The hemodynamic approach to evaluating adolescent varicocele.
abstract: During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack of spontaneous improvement in adolescent patients with ≥ 20% asymmetry between testes. CDUS also enables the detection of varicocele resulting from reflux in the deferential vein adjunctive to a refluxing internal spermatic vein; a causality that accounts for approximately 15% of cases. In addition to a diagnostic role, hemodynamic parameters can be used to predict the risk of persistence or worsening asymmetry. Although further studies are necessary to validate single parameters, it seems that the more severe the reflux, the greater the likelihood that the patient will develop testicular asymmetry.
authors.affiliation: Section of Pediatric Urology, Pediatric Surgery Unit, Department for Mother & Child Care and Urology, University of Palermo, Via Alfonso Giordano 3, 90100 Palermo, Italy. marcello.cimador@ unipa.it
authors.forename: Marcello
authors.initials: M
authors.lastname: Cimador
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.forename: Ignazio
authors.initials: I
authors.lastname: Gattuccio
authors.forename: Marco
authors.initials: M
authors.lastname: Pensabene
authors.forename: Maria
authors.initials: M
authors.lastname: Sergio
authors.forename: Enrico
authors.initials: E
authors.lastname: De Grazia
mesh_terms: D000293:Adolescent; D006439:Hemodynamics; D006801:Humans; D008297:Male; D014646:Varicocele / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery