Gonadal infection: a risk factor for the development of adolescent varicocele

Abstract

Objective: The aim of this study was to determine whether a relationship between previous gonadal infections and adolescent varicocele occurrence exists.

Patients and methods: All adolescents who presented with varicocele at Tanta Urology Department during the period from January 2006 to March 2011 were included in this study. Patients were evaluated for age, clinical presentation, previous history of epididymitis or epididymoorchitis, laterality, and grading of varicocele. Examination of testicular consistency and ultrasound measurement of testicular volume were carried out for all patients to define those with testicular atrophy.

Results: Sixty-three boys were included in this study. The mean patients’ age was 15.6 years (range: 10–18, SD; 1.6 years). Twenty-nine (44.4%) boys had signs of testicular atrophy (testes are soft in consistency with ultrasounddetected volume smaller than that normal for age) either unilateral or bilateral. About 28.6% of patients (18 boys) had a history of epididymitis or epididymo-orchitis either associated with mumps or of unknown etiology. Of those patients, six boys had previous history of single attack, 10 boys had two attacks, and two boys had more than two attacks of epididymo-orchitis. A significant positive correlation was seen between the incidence of epididymo-orchitis attacks and the grade of varicocele (rs=0.63, 95% confidence interval: 0.21–0.85, P<0.05). Patients with past history of epididymo-orchitis were significantly more liable (4.1 times) of developing testicular atrophy as compared with those without a history of epididymo-orchitis (95% confidence interval: 1.517–11.097, P<0.05).

Conclusion: History of epididymo-orchitis is significantly a potential risk factor for the development of adolescent varicocele with subsequently higher risk for testicular atrophy. We advise routine ultrasonographic examinations in patients with previous history of epididymo-orchitis both for possible early detection of varicocele and to avoid testicular atrophy in this cohort of patients. However, more studies on a larger scale are still warranted.

Keywords: adolescent varicocele, epididymo-orchitis, testicular atrophy