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Best practice in the diagnosis and treatment of varicocele in children and adolescents

Overview

A varicocele is defined as an abnormal dilation and tortuosity of the pampiniform plexus venous system that drains the testis. The prevalence of varicocele in the adolescent population has been shown to mirror that of adults. A recent European study that included over 7000 patients found a 15.7% varicocele rate in young males with a median age of 19.1 The prevalence of varicocele in prepubescent boys younger than 10 years of age was much lower at <1%. In 2000, Akbay and colleagues reported a 0.8% prevalence in boys aged 2–6 years, 1.0% at 7–10 years, 7.8% at 11–14 years, and 14.1% at 15–19 years.2 These data suggest that varicoceles are progressive and increase in prevalence as boys approach puberty. Multiple studies have shown a positive association between varicoceles and significantly taller patients with lower body mass indices (BMIs). Alternatively, increasing BMI has a protective effect against varicocele formation.3–5 This association is also seen within the adult population. The majority of varicoceles are left-sided since venous drainage from the testicle enters the left renal vein at a sharp 90° angle as opposed to drainage directly into the inferior vena cava on the right.


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