Prepubertal varicoceles

Varicoceles are rarely detected in prepubertal boys. In an effort to further determine the natural history of prepubertal varicoceles, we have reviewed our experience with prepubertal boys who had varicoceles.

Eleven patients with prepubertal varicoceles were seen. The majority of patients (9 of 11) were asymptomatic. The mean age was 10.8 years (range 6 to 12). Ten of 11 patients had left-sided varicoceles. All varicoceles were grade III except for one that was grade II. Four patients underwent varicocele ligation, 3 via the Ivanessevich approach and 1 via the Palomo approach.

The 4 patients who underwent varicocele ligation (operative group) had a follow-up that ranged from 6 to 72 months (mean 27.2) and the 7 patients who were observed (nonoperative group) had follow-up that ranged from 17 to 84 months (mean 40.8). All patients in the operative group exhibited "catch-up" growth of the affected testicle (mean relative testicular size 47% to 84% at follow-up). The relative left testicular size in the nonoperative group had decreased by a mean of 16.8% from the time of presentation (100% to 83.2% on follow-up).

We conclude that prepubertal boys should be screened in the standing position for the presence of varicoceles. Secondary causes should be excluded. Patients may ultimately require intervention as our initial experience suggests improved testicular growth with early surgical repair.