Paediatric and adolescent varicocele: when, why and how to treat it

Available indicators to justify varicocele treatment in adolescents are insufficient: testis volume is a variable parameter, and testicular asymmetry may be physiological. Testis volume and semen parameters are subject to pubertal development. For evaluation of possible testicular impairment, both parameters should be measured prospectively and at consecutive points in time. Endocrine parameters, which might contribute to a better understanding of possible impairment of testicular function, are neglected in studies. No evidence exists to confirm that varicocele treatment during adolescence leads to the prevention of fertility impairment in adulthood. In summary, risks and benefits of varicocele treatment have to be considered. There is no clear evidence-based recommendation to treat adolescents with varicocele.