The subclinical varicocele debate

The debate concerning the indications to treat subclinical varicocele has been on-going for 15 years. In order to understand this debate we have thoroughly reviewed the literature concerning the arguments for and against its treatment. Arguments posed by 59 investigators who considered the possibility of diagnosing subclinical varicocele were analysed. In 26 of these no definite statements were made concerning the value of treatment, in 29 there were positive statements and in only four were there negative statements. The arguments in favour of treatment were mainly based on positive results from patients and on the assumed lack of correlation between the size of varicocele and the degree of infertility. Although the majority of statements were positive, definite conclusions could not be drawn since data from a randomized prospective trial were not available. Consequently it is concluded that the subclinical varicocele debate can only be resolved by performing a randomized trial with treated and untreated groups of patients. Patients undergoing treatment for subclinical varicocele should be made aware that such treatment might not improve their fertility.