How common are varicocoeles? New data on the prevalence in adolescence and new discussions

Varicocoele is considered to be a common condition, both in the general male population and in men with fertility problems. In some men varicocoeles are accompanied by decreased testicular volume, impaired spermatozoa quality, and decline of Leydig cell secretion (WHO, 1992). An association with impaired semen quality and increased spermatozoa DNA-fragmentation has recently been shown and reviewed (Agarwal et al., 2007). In adolescents with a varicocoele, Tanner stage 5 and marked asymmetry between the testes oligozoospermia were found in almost 60% (Diamond et al., 2007). Surgical correction resulted in an improvement of semen parameters (Zampieri et al., 2007). Varicocoele repair in subfertile couples is effective, at least in a subgroup of men with a clinical varicocoele, oligozoospermia and otherwise unexplained infertility (Baazeem et al., 2011; Kroese et al., 2012). In this issue of Andrology, Rais et al. (2013) have presented a large population study using a nationwide database of over 1.3 million Israeli adolescent males to determine the detected prevalence of varicocoeles as well as associations between varicocoele prevalence and body mass index (BMI). The study is unique in both its gross number of subjects as well as the long duration over which data were available. A study of this magnitude could have a significant impact on the way this condition is viewed and discussed in the future. The authors cite a prevalence of general screening-detected varicocoeles ranging from 1.6 to 4.6% throughout the duration of the study at an average age of 17 years. However, this number is much lower than what has been cited in several other population studies and generally accepted in the urological community (usually quoted at 10–20% of adolescent boys). In three large series of adolescents a prevalence of varicocoele was reported of approximately 15% (Oster, 1971; Steeno et al., 1976; Risser & Lipshultz, 1984). In a more recent study in 6200 boys, varicocoele was found in 4.1% of all investigated boys, whereas in the age group 10–19 years, it was 7.9% (Kumanov et al., 2008). In a WHO-population study 9034 men presenting as partners of infertile couples a prevalence of varicocoele was found of 11.7% of men with normal semen compared with 25.4% of men with abnormal semen (WHO, 1992). The marked differences between the varicocoele prevalences in this study and the prevalences in other large cohorts of young men remain unclear. The true prevalence of this condition is, however, of importance to the paediatric and andrological community because varicoceles can impair future fertility and result in hypogonadism.