title: Varicocele in adolescents: a review and guideline for the daily practice.
abstract: OBJECTIVE
  Varicocele in adolescent men is one of the most challenging topics in pediatric urology. What should be considered as a good indication for treatment and at what  age? Does treatment improve fertility? Can we wait? What is the best surgical and minimal invasive treatment? To answer these questions we provide a  guideline to use in daily practice.
  
  
  METHODS
  We performed a search of the English literature of the last ten years through the Pub Med database using the following key words "varicocele",  "diagnosis",  "treatment", "fertility" and "adolescent". We then summated and compared the results of these studies.
  
  
  CONCLUSIONS
  Adolescents with varicocele need regular follow-up including clinical examination and ultrasound measurements of the testis. Those with a persistent  discrepancy between left and right testis size of more than 20%  over a period of 12 months and those with pain need varicocelectomy independent of patient age,  Tanner stage or varicocele size. The peak retrograde flow (PRF) seems to be a good diagnostic non-invasive tool in the follow-up and can be of help  to select patients  for surgery. PRF=38 cm/s in combination with testicular asymmetry =20% is a reason for surgery independent of age, Tanner stage or varicocele size.  PRF<30 cm/s in combination  with testicular asymmetry <20%  should be followed annually. In case of worsening PRF or asymmetry surgery must be performed. Patients suitable for conservative  management  should be followed until semen analysis is possible. We present a flow-chart to use in the management of adolescent varicocele. The best results of varicocele  treatment  are obtained with microscopic subinguinal and laparoscopic lymphatic spearing techniques as shown in a meta-analysis performed in this review.
authors.affiliation: Department of Urology, University Medical Center Groningen, University of Groningen, Koninginnelaan 46, Groningen, The Netherlands. waalkes.r@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Waalkes
authors.forename: I F
authors.initials: IF
authors.lastname: Manea
authors.forename: J M
authors.initials: JM
authors.lastname: Nijman
mesh_terms: D000293:Adolescent; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D017410:Practice Guidelines as Topic; D055101:Semen Analysis; D013737:Testis / Q000000981:diagnostic imaging / Q000473:pathology; D018615:Ultrasonography, Doppler, Color; D013521:Urologic Surgical Procedures, Male; D014646:Varicocele / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*