Is treatment indicated in adolescents with varicocele? What?

Adolescents rarely consult for painful varicocele. The condition has to be confirmed by physical examination and a detailed Doppler exam. An ultrasoun d may be necessary to measure the size of the testis. About 15 % of all ado lescents have varicoceles. One out of three is graded II or III in the Dubi n and Amelar classification. About 20 % of varicoceles graded III occur in association with testicular hypotrophy. We do not know whether boys with a varicocele will fertility problems later on, but only 13 % of adult men wit h varicocele are infertile. Surgery can be considered as necessary only aft er studying a large number of patients, comparing at random patients operat ed at a young age and followed for 15-20 years with patients not operated a nd with a group of healthy controls. The best treatment has to be selected because of the low risk of testicular atrophy and the disappearance of the varicocele in more than 90 % of the c ases. Inguinal root with microsurgery, and pre or intra-operative radiologi c opacifications are the usual choice of most pediatric surgeons. Laparosco py or retroperitoneoscopy have no major impact on the postoperative results . They are expensive and require great experience. Embolization and other r adiological techniques induce a long period of radiation, are not always po ssible, expensive and demand an experienced radiologist. General anesthesia is required because of the time involved and finally the success rate is l ow. Microsurgical venous reanastomosis is still confidential probably becau se of technical difficulties. Scrotal anterograde sclerotherapy is the simp lest and cheapest treatment and can be performed with a local anesthetic du e to the short time required. But like other procedures, it can induce test icular ischemia.