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Varicocele: standard and alternative indications for repair

Fine, Ronnie G.; Poppas, Dix P.

doi: 10.1097/MOU.0b013e328358e1a4

Purpose of review This review provides timely and relevant information to address the indications for repair of the adolescent varicocele. In this review, we summarize the most recent available evidence and provide clinical guidelines.

Recent findings The indications for adolescent varicocelectomy commonly include testicular hypotrophy and pain but become confusing and contradictory when discussing potential infertility as an indication for repair. The preponderance of patients with varicocele in the infertile population leads to the search for causality and reversibility. However, in the era of assisted reproduction, the question of early prevention of infertility is brought to the forefront of discussion. Recent attempts have been made to determine the patient parameters that predict future infertility. Current publications have focused on predictors for clinically significant varicoceles that would benefit from intervention, such as hormonal profile and peak retrograde flow. Contradictory evidence exists regarding the significance of testicular asymmetry in adolescence.

Summary Substantial effort has been made to tease out the clinically significant adolescent varicocele. However, definitive evidence regarding fertility outcomes and adolescent varicocele repair remains limited and controversial. Large-scale, long-term follow-up studies are necessary to determine the true benefit of adolescent varicocele repair on decreasing the risk of fertility problems in adulthood.

New York Presbyterian Hosptial - Weill Cornell Medical College of Cornell University, New York, New York, USA

Correspondence to Dix Phillip Poppas, MD, FACS, FAAP, Department of Urology, Institute for Pediatric Urology, Komansky Center for Children's Health, James Buchanan Brady Foundation, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 94, New York, NY 10065, USA. Tel: +1 212 746 5336; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.