The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?
The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long-term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.
Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. bryan.sack@childrens.harvard.edu.
Bryan S
BS
Sack
Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.|Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Muehlgasse 19, 90419, Nuremberg, Germany.
Mattias
M
Schäfer
Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
Michael P
MP
Kurtz
D000293:Adolescent; D005298:Fertility; D006801:Humans; D008297:Male; D014646:Varicocele / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*
Adolescence; Paternity; Pediatric urology; Varicocele repair