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Subclinical and Adolescent Varicocele | Chapter 18 | New Frontiers in Medicine and Medical Research Vol. 7

Normal clinical examination and Doppler Ultrasound imaging are used to diagnose sub-clinical varicocele (SCV). SCV was reported to be present in 10–15 percent of infertile patients. SCV is a prevalent cause of initial infertility and a major cause of subsequent infertility in men. As it advances to palpable clinical varicocele, the presence of sub-clinical varicocele in paediatric children is considered a risk factor.

Despite the use of a variety of imaging modalities to identify SCV, Color Doppler Ultrasound is regarded the gold standard imaging for SCV diagnosis, with a sensitivity and specificity of approximately 100%. The diameter of the scrotal veins in supine, upright, and after the valsalva movement, as well as the sum of venous diameter, venous blood flow volume, and retrograde flow direction during the valsalva manoeuvre, are all diagnostic criterion factors for SCV.

SCV has a strong influence on spermatogenesis. The oxidative stress theory is the most widely recognised of all the ideas considered. In many cases, the sole defect linked to oligospermia is SCV.

Various meta-analyses have indicated that surgical intervention improves seminal parameters, however the pregnancy rate does not change significantly when compared to the non-intervened group. The pregnancy rate is at the centre of all surgical management debates. This leaves treating andrologists and urologists even more perplexed as to how to manage these SCV patients. If the goal of varicocelectomy is to enhance pregnancy rates, the American Society of Reproductive Medicine and the American Urological Association do not suggest surgical correction for SCV.

Because of the ethical problems involved in treating a young and immature male, the therapy of teenage varicocele poses even greater challenges. The indications for surgical intervention in such patients have been summarised in guidelines. Both laparoscopic and open procedures have shown excellent results.


Author (S) Details

Sriram Krishnamoorthy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, India.

Ashwin Muthukumar
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, India.

P. M. Venkata Sai
Department of Radiology & Imaging Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai – 600116, India.

Natarajan Kumaresan
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, India.


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