Lawrence S. Ross, M.D. Saelhof Professor Emeritus

Department of Urology UIC

Management of Adolescent Varicocele

Financial and Other Disclosures None

2

I have the following financial interests or

relationships to disclose: Disclosure code

No financial relationships N

Varicoceles are found in 15% of men in the general population

Meacham,et al, J Urol. 1994;151:1535–1538

Varicoceles are found in up to 50% of men with primary infertility & 80% of men with

secondary infertility

Gorelick JI, Goldstein, M, Fert Stert 1993; 59(3): 613-616

ETIOLOGY

90% occur on the left, 10% right or bilateral Hydrostatic pressure differential?

“Nutcracker effect” (mesenteric artery/aorta)?

Increased arterial inflow vs. venous outflow

Elevated NO2 in PP of males with varicocele

Paduch DA, Skoog SJ Rev Urol 2001 Summer; 3(3): 120-133

Pathophysiology

Hyperthermia Abnormal blood flow

Hypoxia and “adrenal reflux”

Endocrine imbalance

Paracrine regulation/disruption

Paduch DA, Skoog SJ Rev Urol 2001 Summer; 3(3): 120-133

Testis Pathology in Varicocele

• Semen: Decreased motility & density, increased abnl forms • Leydig cell hyperplasia, decreased spermatagonia, spermatogenic arrest, sloughing of germinal epithelium, basement membrane damage, peritubular fibrosis

Indications for Treatment of Adult Varicocele

• Varicocele palpable on physical examination • Couple has known infertility • Female has normal fertility or treatable cause of infertility • Male has abnormal semen parameters or function tests

Varicocele treatment is not indicated in men with normal semen quality or subclinical varicocele

Sharlip, ID, et al, Report on Varicocele and Infertility: AUA Best Practice Policy & ASRM Practice Committee Report, ISBN 0-9649702-1-5 (Volume 4) ISBN 09649702-6-0 (4 Volume set), 2001

Varicocele Repair Results

• Varicocele is most common correctable cause of infertility (1) • Post varicocele repair 60-70% semen improvement (2) • Post varicocele repair 40-50% couples achieve pregnancy (2)

1. Greenberg SH, Lipshultz LI, Wein AJ. J Urol. 1978;119: 507-510 2. Pryor JL, Howards SS, Urol Clin North Am. 1987; 14:499-513

Adolescent Varicocele

Incidence of Varicocele in General Population of Healthy Adolescents No. of Patients Age (y) Incidence(Total) Oster 1971 837 10–19 16.2% Steeno 1976 4067 12–25 14.7% Yerokhin 1979 10,000 10–17 12.4% Belloli 1993 9861 10–16 16.0% Niedzielski 1997 2478 10–20 17.8%

Paduch DA, Skoog SJ Rev Urol 2001 Summer; 3(3): 120-133

Indications for Adolescent Varicocele Repair

• Effect on Testicular Growth with Loss of Volume • Progressive Deterioration in Semen Analysis

FACTS!

Gorelick JI, Goldstein, M, Fert Stert 1993; 59(3): 613-616 Sayfan, et al, J Urol 1997; 157: 1456-1457

Indications for Adolescent Varicocele Repair

FACTS!

• Testis growth rate failure reversed by repair of varicocele (1) • Semen analysis improves in 60-70% of men post Varix repair(2)

1. Kass EJ, Belman AB. J Urol. 1987; 137:475-476 2. Pryor JL, Howards SS, Urol Clin North Am. 1987; 14:499-513

When Do I Repair Adolescent Varicocele?

• 20-30% lag in testis growth rate with ipsilateral varicocele • Abnormal semen analysis in Tanner 5 male • Bilateral varicoceles • ? Painful varicocele

Thank You!