Repair Versus Observation in Adolescent Varicocele

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Abstract
We designed a randomized prospective study of male adolescents with moderate and severe varicoceles to determine whether prophylactic varicocele repair is beneficial. We evaluated 2,100 boys (10 to 20 years old) for genitourinary abnormalities. From this population 2 groups of adolescents 15 to 19 years old with grade 2 or 3 varicoceles were created, including 88 who underwent varicocele repair and 36 controls. Testicular volume and pampiniform vein diameter were measured, and Doppler ultrasound was performed. After 12 months volume of the involved left testis increased to almost normal in treated boys (mean atrophy index 12.7% at surgery and 3% 12 months later). In controls the corresponding atrophy indexes were 10 and 9%, respectively. The relative increase in left testicular volume was 26% in the surgery group and 11% in controls. In the surgery group mean pampiniform vein diameter decreased from 2.8 preoperatively to 2 mm. postoperatively but there was no change in controls. Varicocele repair in adolescents with moderate and severe varicocele reversed testicular growth arrest and resulted in catch-up growth within 12 month of surgery.