Subclinical varicocele and sports: a longitudinal study

To evaluate the influence of physical activity on the evolution of subclinical varicocele because subclinical and clinical varicoceles are common in adolescents.

The study enrolled healthy male volunteers (athletes and nonathletes) and athletes with subclinical varicocele from October 2006 to March 2007. A fourth group of nonathletes with subclinical varicocele was created. Subclinical varicocele was defined as spermatic vein reflux detected with Doppler velocimetry only with the Valsalva maneuver. All patients were pubertal boys of 14-16 years old. Those practicing sports on a regular basis ≥3 times weekly for ≥2 consecutive hours were considered athletes. The boys were examined every year for 3 years from October 2006 to March 2010. At each examination, each patient underwent Doppler velocimetry and testicular volume measurements with a standard orchidometer. The rate of progression to a clinically palpable varicocele and its relationship to sport practice was also assessed.

The follow-up compliance rate was 80%. The rate of progression to a clinically palpable varicocele was significantly greater in the athletes with a subclinical varicocele than in the healthy group (athletes and nonathletes) without a subclinical varicocele (36% vs 5%, respectively; P < .05). The probability of developing a subclinical varicocele for healthy athletes and healthy nonathletes was similar (23% vs 20%, respectively).

Subclinical varicocele should be considered as the first stage of varicocele development. Although sports practice seemed to cause progression to a clinical varicocele, this finding was confirmed only in patients already affected by spermatic vein reflux (subclinical varicocele).