About 4.6–16.2% of male adolescents may be affected by varicocele. The most
important damaging effect of varicocele in adolescents is testicular growth arrest
(hypotrophy). Ultrasound is more accurate compared with orchidometry in detecting
hypotrophy. Histopathologically, the testis of adolescent boys affected by varicocele
shows Leydig cell hyperplasia, decreased number of spermatogonia per tubule,
spermatogenesis arrest, and sloughing of the germinal epithelium. Varicocele in
adolescents negatively affects sperm density and motility, and this seems to be related
to testicular volume. To treat or not to treat adolescent varicocele is a controversial
question. This is due to conflicting reports about the effectiveness of varicocelectomy.
On one hand, some studies demonstrated a significant catch-up growth of the testis
but found that prophylactic varicocele repair might expose many individuals to the
unnecessary risks of surgery. Furthermore, this catch up of testicular volume could be
due to edema secondary to severing of lymphatics during the procedure. On the other
hand, other studies found that varicocele correction in adolescents not only improved
testicular hypotrophy but also improved semen quality. Complications of
varicocelectomy, such as recurrence or hydrocele incidence, are less common in open
varicocelectomy than in laparoscopic or percutaneous embolization when treating
varicocele in adolescents.