Varicocele.

Approximately one third of infertile men present with varicocele, while the incidence among males in the general public is approximately 15 per cent. The etiology may be a longer left spermatic vein with its right-angle insertion into the left renal vein and/or absence of valves, which causes a higher hydrostatic pressure in the left spermatic vein causing dilatation. The nutcracker phenomenon is also a possible etiology. Much of the pathophysiology is still unknown, but increased blood flow causing an elevated intratesticular temperature may be of significance. Though there are many recent reports on the importance of a subclinical varicocele, we are not convinced of its significance. The best method for diagnosis remains a good clinical examination. The incidence of adolescents with varicocele is about the same as men with varicocele (approximately 15 per cent). Adolescents with varicocele should be treated if the testicular mass is decreased or if they are symptomatic. Surgical ligation is still the preferred method of treatment. Percutaneous treatment of varicoceles has an approximately 11 per cent incidence of minor complications and an occlusion rate of 73 per cent with a recurrence rate of 5 per cent. We reserve percutaneous treatment for recurrent varicoceles after surgical ligation, but primary percutaneous therapy is a reasonable approach.