[Early diagnosis and correct treatment of varicocele in puberty]

Varicocele normally presents itself in adolescence, with an incidence of 16 per cent. Less than one third of the boys, though, will suffer from male infertility in adulthood. Therefore, it seems excessive as well as imprudent to suggest surgery to all those patients. We worked out some parameters to identify "risky" cases of varicocele. From June to November 1990 we studied 45 patients from 10 to 16 years of age affected by varicocele, taking into consideration the following factors: puberal phase, symptomatology, degree of varicocele, testicular volume, Doppler ultrasound, hormonal profile. A Doppler ultrasound test evidenced a clinically undetected right reflux, in addition to a left varicocele, in 13 patients (34.4%). Sixty per cent of these 13 patients revealed a pathological response to LHRH test; this incidence is very close to that evidence in clinical bilateral varicocele. We believe that a right reflux showed by ultrasounds, represents a cause of further alteration in the patient's endocrinological balance in addition to increasing his risk of infertility. Purpose of this study was to draw a guideline for early diagnosis, correct treatment and follow-up of varicocele in peripubertal age.