Ces Urol 2014, 18(3):191-198 | DOI: 10.48095/cccu2014031

Varicocele

Zuzana Vaľová, Radim Kočvara, Tomáš Hanuš

Urologická klinika 1. LF UK a VFN, Praha

Varicocele is rare in boys under 10 years of age, and becomes more frequent at the beginning of puberty. It is mostly asymptomatic and fertility problems arise in about 20% of adolescents. Venous reflux into the plexus pampiniformis is diagnosed using Doppler colour flow mapping in the supine and upright position. Clinical varicocele is palpable without the Valsalva maneuver (grade II) and is visible at a distance (grade III).
The size of testis should be evaluated by palpation, orchidometry, but preferably by ultrasound. The surgical methods of choice are subinguinal or inguinal microsurgical (microscopic) repairs, or suprainguinal open or laparoscopic lymphatic-sparing repairs.
The recommended criteria for varicocelectomy in children and adolescents include varicocele associated with a small testis, additional testicular condition affecting fertility, bilateral palpable varicocele, pathological sperm quality (in older adolescents), and symptomatic varicocele. Other varicoceles should be followed until the patient reached 17-18 years of age. At that time, a reliable sperm analysis can be performed.

Keywords: varicocele, ultrasonography in varicocele, artery and lymphatic-sparing varicocele, micro-surgical varicocelectomy

Received: February 8, 2014; Accepted: April 29, 2014; Published: June 1, 2014