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Clinical Management and Treatment of Varicocele in the Adolescence

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Pediatric and Adolescent Andrology

Abstract

Pediatric varicocele, having a prevalence between 1 and 15% according to age, is more frequent as puberty begins. By interfering with Sertoli cell proliferation and hormone secretion, testicular growth, and spermatogenesis, it can damage testicular function. Proper management has a pivotal role for future fertility preservation. In this chapter, diagnosis, management, and treatment of childhood and adolescent varicocele will be discussed from an endocrinological perspective, overviewing the current evidence and the established guidelines by the European Society for Pediatric Urology, the European Association of Urology, the American Urological Association, and the American Society for Reproductive Medicine.

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Abbreviations

ASRM:

American Society for Reproductive Medicine

AUA:

American Urological Association

EAU:

European Association of Urology

ESPU:

European Society for Pediatric Urology

FSH:

Follicle-stimulating hormone

HSP:

Heat shock proteins

LH:

Luteinizing hormone

NcP:

Nutcracker phenomenon

OR:

Oxidative stress

PRF:

Peak retrograde flow

ROS:

Reactive oxygen species

References

  1. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, Marmar JL. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007;70(3):532–8.

    Article  Google Scholar 

  2. Damsgaard J, Joensen UN, Carlsen E, Erenpreiss J, Blomberg Jensen M, Matulevicius V, Zilaitiene B, Olesen IA, Perheentupa A, Punab M, Salzbrunn A, Toppari J, Virtanen HE, Juul A, Skakkebæk NE, Jørgensen N. Varicocele is associated with impaired semen quality and reproductive hormone levels: a study of 7035 healthy young men from six European countries. Eur Urol. 2016;70(6):1019–29. https://doi.org/10.1016/j.eururo.2016.06.044. Epub 2016 Jul 14.

    Article  CAS  PubMed  Google Scholar 

  3. Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M. The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. BJU Int. 2000;86(4):490–3.

    Article  CAS  Google Scholar 

  4. Mongioì LM, Mammino L, Compagnone M, Condorelli RA, Basile A, Alamo A, La Vignera S, Morgia G, Russo GI, Calogero AE. Effects of varicocele treatment on sperm conventional parameters: surgical varicocelectomy versus sclerotherapy. Cardiovasc Intervent Radiol. 2019;42(3):396–404.

    Article  Google Scholar 

  5. Kirby EW, Wiener LE, Rajanahally S, Crowell K, Coward RM. Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril. 2016;106(6):1338–43. https://doi.org/10.1016/j.fertnstert.2016.07.1093. Epub 2016 Aug 12.

    Article  PubMed  Google Scholar 

  6. La Vignera S, Condorelli R, Vicari E, D’Agata R, Calogero AE. Effects of varicocelectomy on sperm DNA fragmentation, mitochondrial function, chromatin condensation, and apoptosis. J Androl. 2012;33(3):389–96.

    Article  Google Scholar 

  7. Li F, Yue H, Yamaguchi K, Okada K, Matsushita K, Ando M, Chiba K, Fujisawa M. Effect of surgical repair on testosterone production in infertile men with varicocele: a meta-analysis. Int J Urol. 2012;19(2):149–54. https://doi.org/10.1111/j.1442-2042.2011.02890.x. Epub 2011 Nov 8.

    Article  CAS  PubMed  Google Scholar 

  8. Cho CL, Esteves SC, Agarwal A. Indications and outcomes of varicocele repair. Panminerva Med. 2019;61(2):152–63.

    Article  Google Scholar 

  9. Chung JM, Lee SD. Current issues in adolescent varicocele: pediatric urological perspectives. World J Mens Health. 2018;36(2):123–31. https://doi.org/10.5534/wjmh.170053. Epub 2018 Mar 22.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nork JJ, Berger JH, Crain DS, Christman MS. Youth varicocele and varicocele treatment: a meta-analysis of semen outcomes. Fertil Steril. 2014;102(2):381–387.e6.

    Article  Google Scholar 

  11. Diamond DA, Zurakowski D, Bauer SB, Borer JG, Peters CA, Cilento BG Jr, Paltiel HJ, Rosoklija I, Retik AB. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents. J Urol. 2007;178(4 Pt 2):1584–8.

    Article  Google Scholar 

  12. Hassanin AM, Ahmed HH, Kaddah AN. A global view of the pathophysiology of varicocele. Andrology. 2018;6(5):654–61. https://doi.org/10.1111/andr.12511. Epub 2018 Jul 6.

    Article  CAS  PubMed  Google Scholar 

  13. Condorelli RA, Cannarella R, Calogero AE, La Vignera S. Evaluation of testicular function in prepubertal children. Endocrine. 2018;62(2):274–80.

    Article  CAS  Google Scholar 

  14. Hu JT, Shao CH, Wang PT, Liu Y, Hao WY, Feng YL, Liu SH, Wang XS. High temperature reduces the proliferation of and occludin expression in rat Sertoli cells in vitro. Zhonghua Nan Ke Xue. 2012;18(10):920–4.

    CAS  PubMed  Google Scholar 

  15. Macey MR, Owen RC, Ross SS, Coward RM. Best practice in the diagnosis and treatment of varicocele in children and adolescents. Ther Adv Urol. 2018;10(9):273–82. https://doi.org/10.1177/1756287218783900. eCollection 2018 Sep.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970;21(8):606–9.

    Article  CAS  Google Scholar 

  17. Pauroso S, Di Leo N, Fulle I, Di Segni M, Alessi S, Maggini E. Varicocele: Ultrasonographic assessment in daily clinical practice. J Ultrasound. 2011;14(4):199–204.

    Article  CAS  Google Scholar 

  18. Englund KM, Rayment M. Nutcracker syndrome: a proposed ultrasound protocol. Austr J Ultrasound Med Banner. 2018;21(2):75–8.

    Article  Google Scholar 

  19. Hannick JH, Blais AS, Kim JK, Traubici J, Shiff M, Book R, Lorenzo AJ. Prevalence, Doppler ultrasound findings, and clinical implications of the nutcracker phenomenon in pediatric varicoceles. Urology. 2019;128:78–83.

    Article  Google Scholar 

  20. Condorelli RA, Calogero AE, Vicari E, Mongioi’ L, Burgio G, Cannarella R, Giacone F, Iacoviello L, Morgia G, Favilla V, Cimino S, La Vignera S. Reduced seminal concentration of CD45pos cells after follicle-stimulating hormone treatment in selected patients with idiopathic oligoasthenoteratozoospermia. Int J Endocrinol. 2014;2014:372060.

    PubMed  PubMed Central  Google Scholar 

  21. Jedrzejewski G, Osemlak P, Wieczorek AP, Nachulewicz P. Prognostic values of shear wave elastography in adolescent boys with varicocele. J Pediatr Urol. 2019;15(3):223.e1–5.

    Article  CAS  Google Scholar 

  22. Dabaja AA, Wosnitzer MS, Bolyakov A, Schlegel PN, Paduch DA. When to ask male adolescents to provide semen sample for fertility preservation? Transl Androl Urol. 2014;3(1):2–8.

    PubMed  PubMed Central  Google Scholar 

  23. Fine RG, Gitlin J, Reda EF, Palmer LS. Barriers to use of semen analysis in the adolescent with a varicocele: survey of patient, parental, and practitioner attitudes. J Pediatr Urol. 2016;12(1):41.e1–6.

    Article  Google Scholar 

  24. Haans LC, Laven JS, Mali WP, te Velde ER, Wensing CJ. Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varicocele. Fertil Steril. 1991;56(4):731–6.

    Article  CAS  Google Scholar 

  25. Paduch DA, Niedzielski J. Semen analysis in young men with varicocele: preliminary study. J Urol. 1996;156(2 Pt 2):788–90.

    CAS  PubMed  Google Scholar 

  26. Romeo C, Arrigo T, Impellizzeri P, Manganaro A, Antonuccio P, Di Pasquale G, Messina MF, Marseglia L, Formica I, Zuccarello B. Altered serum inhibin b levels in adolescents with varicocele. J Pediatr Surg. 2007;42(2):390–4.

    Article  Google Scholar 

  27. Niu XB, Tang J, Wang HB, Yan L, Zhang CY, Wang GC, Liang J, Dou XY, Fu GB. Inhibin B level helps evaluate the testicular function of prepubertal patients with varicocele. Zhonghua Nan Ke Xue. 2018;24(7):618–21.

    PubMed  Google Scholar 

  28. Trigo RV, Bergadá I, Rey R, Ballerini MG, Bedecarrás P, Bergadá C, Gottlieb S, Campo S. Altered serum profile of inhibin B, pro-alphaC and anti-Müllerian hormone in prepubertal and pubertal boys with varicocele. Clin Endocrinol. 2004;60(6):758–64.

    Article  CAS  Google Scholar 

  29. Chu DI, Zderic SA, Shukla AR, Srinivasan AK, Tasian GE, Weiss DA, Long CJ, Canning DA, Kolon TF. The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study. J Pediatr Urol. 2017;13(1):77.e1–5.

    Article  Google Scholar 

  30. Kolon TF, Clement MR, Cartwright L, Bellah R, Carr MC, Canning DA, Snyder HM. Transient asynchronous testicular growth in adolescent males with a varicocele. J Urol. 2008;180(3):1111–4; discussion 1114-5.

    Article  Google Scholar 

  31. Kozakowski KA, Gjertson CK, Decastro GJ, Poon S, Gasalberti A, Glassberg KI. Peak retrograde flow: a novel predictor of persistent, progressive and new onset asymmetry in adolescent varicocele. J Urol. 2009;181(6):2717–22; discussion 2723.

    Article  Google Scholar 

  32. Van Batavia JP, Badalato G, Fast A, Glassberg KI. Adolescent varicocele-is the 20/38 harbinger a durable predictor of testicular asymmetry? J Urol. 2013;189(5):1897–901.

    Article  Google Scholar 

  33. Cimador M, Castagnetti M, Gattuccio I, Pensabene M, Sergio M, De Grazia E. The hemodynamic approach to evaluating adolescent varicocele. Nat Rev Urol. 2012;9(5):247–57.

    Article  Google Scholar 

  34. Glassberg KI. My indications for treatment of the adolescent varicocele (and why?). Transl Androl Urol. 2014;3(4):402–12.

    PubMed  PubMed Central  Google Scholar 

  35. Mancini M, Carrafiello G, Melchiorre F, Pelliccione F, Andreassi A, Mantellassi G, Ahmed Said Z, Pecori Giraldi F, Banderali G, Folli F. Early varicocelectomy by percutaneous scleroembolization improves seminiferous tubules spermatozoa release in the adolescent phase of testicular growth. Andrologia. 2019;51(7):e13286.

    Article  Google Scholar 

  36. Li F, Chiba K, Yamaguchi K, Okada K, Matsushita K, Ando M, Yue H, Fujisawa M. Effect of varicocelectomy on testicular volume in children and adolescents: a meta-analysis. Urology. 2012;79(6):1340–5.

    Article  Google Scholar 

  37. Bogaert G, Orye C, De Win G. Pubertal screening and treatment for varicocele do not improve chance of paternity as adult. J Urol. 2013;189(6):2298–303.

    Article  Google Scholar 

  38. Çayan S, Şahin S, Akbay E. Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only: a single institution experience with 408 patients. J Urol. 2017;198(1):195–201.

    Article  Google Scholar 

  39. Silay MS, Hoen L, Quadackaers J, Undre S, Bogaert G, Dogan HS, Kocvara R, Nijman RJM, Radmayr C, Tekgul S, Stein R. Treatment of varicocele in children and adolescents: a systematic review and meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol. 2019;75(3):448–61.

    Article  Google Scholar 

  40. Dong W, Yao Y, Huang H, Han J, Zhao X, Huang J. Surgical management of nutcracker phenomenon presenting as left varicocele in adolescents: a novel approach. J Pediatr Urol. 2014;10(3):424–9.

    Article  Google Scholar 

  41. Practice Committee of the American Society for Reproductive Medicine, Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril. 2014;102(6):1556–60.

    Article  Google Scholar 

  42. Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, Krausz C, European Association of Urology Working Group on Male Infertility. European Association of Urology guidelines on male infertility: the 2012 update. Eur Urol. 2012;62(2):324–32.

    Article  Google Scholar 

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Correspondence to Sandro La Vignera .

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Cannarella, R., Calogero, A.E., Condorelli, R.A., Giacone, F., Aversa, A., La Vignera, S. (2021). Clinical Management and Treatment of Varicocele in the Adolescence. In: Foresta, C., Gianfrilli, D. (eds) Pediatric and Adolescent Andrology. Trends in Andrology and Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-80015-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-80015-4_7

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