NEW YORK (Reuters Health) - Varicocelectomy performed during adolescence seems to preserve fertility and testicular growth, physicians in New York report.

If varicocele repair is postponed until adulthood, infertility may develop and the ability to conceive is regained in only about half of patients who undergo the procedure, Dr. Kenneth I. Glassberg and colleagues explain in their paper, published in the December issue of Pediatrics. Reversal of testicular atrophy does not usually occur after varicocele repair in adulthood.

Adolescent varicocelectomy has become more frequent over the last decade, the authors continue. However, there is still no consensus regarding which patients should be treated and there are no long-term follow-up studies on subsequent paternity in this patient population.

Dr. Glassberg, at Columbia University, and his associates followed 43 patients who had been treated in adolescence (average age 15 years) for an average of 9 years (average age at follow-up 24 years).

Of 11 patients with significant volume difference between the two testicles, catch-up growth occurred in nine. There were also two patients with two small testicles who underwent bilateral varicocelectomy, and in both cases testicles grew appropriately after repair, the authors note.

Of the 18 subjects who attempted to father a child, all were successful within 1 year.

"We contend that varicocelectomy in adolescence at worst does no harm and at best preserves fertility and testicular growth," Dr. Glassberg's group writes.

"Examination of the adolescent male to identify the presence of varicocele should be routine for the practicing pediatrician," Dr. A. Barry Belman, a pediatric urologist at George Washington University in Washington, DC, comments in a related editorial.

"Identification of a varicocele should prompt referral to a pediatric urologist and the determination as to treatment made as objectively as possible," he adds.

Pediatrics 2004;114:1631-1633

Pediatrics 2004;114:1669-1670

Copyright © 2003 Reuters Limited. All rights reserved. Republication or redistribution of Reuters Limited content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters Limited. Reuters Limited shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.