Varicocele in children and adolescents. History and current view and state of problem (literature review)




varicocele, microsurgical subgingival varicocelectomy, children


A literature review on the subject of varicocele in children which include historical data and question about: etiopathogenesis, epidemiology, diagnostics, treatment and long-term outcomes. The diagnostic method of varicocele unchanged until the XX century and consisted of visual examination and palpation with or without Valsava maneuver. But after entering in diagnostic protocol contrast venography, thermography of testis and ultrasound examination, this protocol have significant changes. For a long time, phlebography has been considered the «gold standard» for the diagnosis of varicocele. But the big disadvantage of this procedure is high invasiveness. Doppler ultrasound mapping has given a new impuls to the diagnosis of varicocele due to minimally invasiveand accessible. G. Liguori, C. Trombetta in their work showed that surgical treatment of varicocele should begin when the testicle size is reduced by more than 20%, or 2 ml of volume in ultrasound examination. Also, the visualization of reflux into the seminal vein is more specific in the ultrasound examination. G. Sigmund et al. introduced the concept of stop-type, shunt-type reflux into the seminal vein. However, in the case of unexplained recurrent varicocele, only antegrade venography can provide sufficient information. The review presents the classic and alternative surgical treatments of varicocele in children. Today it is safe to say that the treatment of varicocele has entered to the era of modern evidence-based medicine. A large number of studies indicate that the expansion of the testicular plexus has a progressive detrimental effect on testicular tissue and leads to a deterioration in sperm count. The methods witch used to correct varicocele earlier was traumatic, but modern surgery has brought many innovative technologies and methods of surgical correction. In addition, there have been impressive developments in bimolecular and functional sperm tests. Nowdays gold standard of surgical treatment varicocele is microsurgical subgingival varicocelectomy but this operation has one big disadvantage. This is possible damage of the testicular artery. The solution of this problem can be obtained by finding new intraoperative way of visualization and defending testicular artery and lymphatic vessels.

No conflict of interest was declared by the authors.


Aaberg RA, Vancaillie TG, Schuessler WW. (1991). Laparoscopic varicocele ligation: a new technique. Fertil Steril. 56: 776-777.

Ahlberg NE, Bartley O, Chidekel N. (1966). Right and left gonadal veins. An anatomical and statistical sActa Radiol Diagn (Stockh). 4: 593-601.; PMid:5929114

Akbay E et al. (2000). The prevalence of varicocele and varicocelerelated testicular atrophy in Turkish children and adolescents. BJU Int. 86: 490.; PMid:10971279

Barwell R. (1885). One hundred cases of varicocele treated by the subcutaneous wire loop. Lancet. 1: 978-980.

Bassini E. (1887). Sulla cura radicale dell'ernia inguinale. Arch Soc Ital Chir. 4: 380-388.

Bennett WH. (1889). Varicocele, particularly with reference to its radical cure. Lancet. 1: 261-268.

Bonafini B, Pozzilli P. (2012). Scrotal asymmetry, varicocoele and the Riace Bronzes. Int J Androl. 35: 181-182.; PMid:22288773

Braedel HU, Steffens J, Ziegler M, Polsky MS, Platt ML. (1994). A possible ontogenic etiology for idiopathic left varicocele. J Urol. 151: 62-66.

Cayan S, Shavakhabov S, Kadioglu A. (2009). Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 30: 33-40.; PMid:18772487

Comhaire F, Kunnen M, Nahoum C. (1981). Radiological anatomy of the internal spermatic vein(s) in 200 retrograde venograms. Int J Androl. 4: 379-387.; PMid:7263093

Comhaire F, Vermeulen A. (1974). Varicocele sterility: cortisol and catecholamines. Fertil Steril. 25: 88-95.

Coolsaet BL. (1980). The varicocele syndrome: venography determining the optimal level for surgical management. J Urol. 124: 833-839.

Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F et al. (2005). Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 19: 117-119.; PMid:15549629

De Varicocele. Dissertatio Inauguralis Medica Quam Consensu Et Auctoritate Gratiosi Medicorum Ordinis In Alma Literarum Universitate Friderica Guilelma Ut Summi In Medicina Et Chirurgia Honores Rite Sibi Tribuantur Die XXII. M. Augusti A. MDCCCLI. H. L. Q. S. Publice Defendet Auctor Aemilius Stachelscxseib Guestphalus. Opponentibus: F. Fonck, Med Et Chir. Dr. G. Sarrazin, Med. Et Chiv. Dr. H. Martin, Jur Stud. Berolini, Typis Fratrum Schlesinger. 1851.

Diegidio P, Jhaveri JK, Ghannam S, Pinkhasov R, Shabsigh R, Fisch H. (2011). Review of current varicocelectomy techniques and their outcomes. BJU Int. 108: 1157-1172. PMid:21435155

Doganay E. (2015). Sir Astley Paston Cooper (17681841): The man and his personality. J Med Biogr. 23: 209216.

Gendel V, Haddadin I, Nosher JL. (2011). Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review. World J Radiol. 3: 194-198.; PMid:21860716 PMCid:PMC3158898

Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. (1992). Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 148: 1808-1811.

Hagood PG, Mehan DJ, Worischeck JH, Andrus CH, Parra RO. (1992). Laparoscopic varicocelectomy: preliminary report of a new technique. J Urol. 147: 73-76.

Havrylyuk AM, Chopyak VV, Nakonechnyi IoA, Nakonechnyi AIo, Fraczek M, Kurpisz M. (2017). Cryptorchidism and varicocele: аnother look at the reasons for launching autoaggression. Paediatric Surgery.Ukraine. 3 (56): 75-83.

Ivanissevich O. (1960). Left varicocele due to reflux. Experience with 4470 operative cases in forty-two years. J IntColl Surg. 34 (12): 742-755.

Lau JL, Lo R, Chan FL, Wong KK. (1986). The posterior «nutcracker»: hematuria secondary to retroaortic left renal vein. Urology. 28: 437-439.

Levinger U, Gornish M, Gat Y, Bachar GN. (2007). Is varicocele prevalence increasing with age? Andrologia. 39 (3): 77-80.; PMid:17683466

Liguori G, Trombetta C, Garaffa G, Bucci S, Gattuccio I, Salame L et al. (2004). Color Doppler ultrasound investigation of varicocele. World J Urol. 22: 378-381.; PMid:15322805

Lima SS, Castro MP, Costa OF. (1978). A new method for the treatment of varicocele. Andrologia. 10: 103-106.; PMid:646140

MacLeod J. (1965). Seminal cytology in the presence of varicocele. Fertil Steril. 16: 735-757.

Macomber D, Sanders MB. (1929). The spermatozoa count: Its value in the diagnosis, prognosis, and treatment of sterility. N Engl J Med. 200: 981-984.

Marmar JL, DeBenedictis TJ, Praiss D. (1985). The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 43: 583-588.

Marmar JL, Kim Y. (1994). Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 152: 1127-1132.

Marmar JL. (2001). The pathophysiology of varicoceles in the light of current molecular and genetic information. Hum Reprod Update. 7: 461-472.


Marmar JL. (2016). The evolution and refinements of varicocele surgery. Asian J Androl. 18: 171-178.; PMid:26732111 PMCid:PMC4770481

Marte A, Pintozzi L, Cavaiuolo S, Parmeggiani P. (2014). Singleincision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques. Afr J Paediatr Surg. 11: 201-205.; PMid:25047308

Narath A. (1900). Zur Radical operation der Varikocele. Wien Klin Wochenschrift. 13: 73-79.

Oster J. (1971). Varicocele in children and adolescents. An investigation of the incidence among Danish school children. Scand J Urol Nephrol. 5: 27.; PMid:5093090

Palomo A. (1949). Radical cure of varicocele by a new technique; preliminary report. J Urol. 61: 604-607.

Paul Dziallas. (1949). Uber die Klappenverhaltnisse der Venae spermaticae des Menschen. Anat Anz: 9757-9763.

Petros JA, Andriole GL, Middleton WD, Picus DA. (1991). Correlation of testicular color Doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility. J Urol. 145: 785-788.

Poizat R et al. (1983, Apr 28). Sem Hop Varicocele and infertility. Facts, uncertainties and hypotheses Paris. 59 (17): 1341-1347.

Pott P. (1762). Practical remarks on the hydrocele or Watry Rupture. C Hitch and L Hawes, London: 161-162.

Rawling EG. (1968). Sir Astley Paston Cooper, 1768-1841: «the prince of surgery». Can Med Assoc J. 99: 221-225.

Rusak PS, Shevchuk DV, Danylov OA, Voloshyn PI. (2006). Sposib likuvannia idiopatychnoho rozshyrennia ven simianoho kanatyka u ditei ta pidlitkiv Pat. No. 12881 UA MPK A61R 9/14 (2006/1) zh. Promyslova vlasnist. Ofitsiinyi biuleten. 3. 15.03.2006.

Shen JT, Weinstein M, Beekley A, Yeo C, Cowan S. (2014). Ambroise Pare (1510 to 1590): a surgeon centuries ahead of his time. Am Surg. 80: 536-538.; PMid:24887788

Shevchuk DV. (2008). Optymizatsiia khirurhichnoho likuvannia varykotsele u ditei: Dys kand nauk: 14.01.09.

Shigami K, Yoshida Y, Hirooka M, Mohri K. (1970). A new operation for varicocele: use of microvascular anastomosis. Surgery. 67: 620-623.

Shiraishi K, Takihara H, Matsuyama H. (2010). Elevated scrotal temperature, but not varicocele grade, reflects testicular oxidative stress-mediated apoptosis. World J Urol. 28: 359-364.; PMid:19655149

Sigmund G, Gall H, Bahren W. (1987). Stop-type and shunt-type varicoceles: venographic findings. Radiology. 163: 105-110.; PMid:3547489

Sofikitis N, Dritsas K, Miyagawa I, Koutselinis A. (1993). Anatomical characteristics of the left testicular venous system in man. Arch Androl. 30: 79-85.; PMid:8470944

Sofikitis N, Miyagawa I. (1993). Left adrenalectomy in varicocelized rats does not inhibit the development of varicocele-related physiologic alterations. Int J Fertil Menopausal Stud. 38: 250-255.

Steeno O, Koumans J, De Moor P. (1976). Adrenal cortical hormones in the spermatic vein of 95 patients with left varicocele. Andrologia. 8: 101-104.; PMid:962168

Tessler A, Krahn HP. (1966). Varicocele and testicular temperature. Fertil Steril. 17: 201-203.

Tiseo BC, Esteves SC, Cocuzza MS. (2016). Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men. Asian J Androl. 18: 239-245.; PMid:26806080 PMCid:PMC4770493

Trum JW, Gubler FM, Laan R, van der Veen F. (1996). The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum Reprod. 11: 1232-1235.; PMid:8671430

Tulloch WS. (1952). A consideration of sterility factors in the light of subsequente pregnancies. II. Sub fertility in the male. Tr Edinburgh Obst Soc Session 104. Edinb Med J. 59: 29-34.

Valla JS. (2008). One-port Retroperitoneoscopic Varicocelectomy in Children and Adolescents. In: Bax K, Georgeson EK, Rothenberg SS, Valla JS, Yeung CK, editors. Endoscopic Surgery in Infants and Children. Berlin, Heidelberg: SpringerVerlag: 765-769.

Weinbauer GF et al. (2010). Male Reproductive Health and Dysfunction. Andrology: 37.

World Health Organization. (1985). Comparison among different methods for the diagnosis of varicocele. Fertil Steril. 43: 575-582.