Varix ligation is indicated in patients with a palpable varix and at least one of the following: (i) pain that is not attributable to other intrascrotal pathology (17); (ii) adolescent ipsilateral testis volume loss of 2 ml or greater than 20% of volume (18-21); or (iii) infertility attributable to the male partner based upon abnormal semen analysis or abnormal results of sperm function tests associated with a female partner who is fertile or suffers a treatable cause of subfertility (16). Treatment of varicocele is not indicated for infertility if the male partner has normal semen quality or a subclinical varicocele (16). Men with palpable varicoceles and abnormal semen quality who are not currently attempting conception but are interested in preservation of fertility may wish to undergo varix ligation when informed of the progressive deterioration of semen quality associated with varicocele (5,7,9). Varix ligation is cost-effective in comparison to alternate treatments, which might include assisted reproductive techniques such as in vitro fertilization with or without intracytoplasmic sperm injection (22,23). Young men with asymptomatic varicoceles and normal semen parameters should be followed with semen analyses and physical examination every one to two years. Adolescents with an asymptomatic varicocele and normal ipsilateral testicular size should be offered annual examination and measurement of testicular size. Repair should be offered at the first sign of testicular or semen abnormality (16). Varix ligation is not recommended for a subclinical varicocele or for prophylaxis in the asymptomatic adolescent (2,24).
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