title: Variations in the management of asymptomatic adolescent grade 2 or 3 left varicoceles: a survey of practitioners.
abstract: OBJECTIVE
  Our study aims to evaluate variations in management of asymptomatic adolescent grade 2 and 3 varicoceles by pediatric urologists.
  
  
  METHODS
  Electronic survey of all 267 current members of AAP Urology with 74 (28%) responding.
  
  
  RESULTS
  When managing patients with positive examination findings, 49% of surveyed practitioners use scrotal sonography as initial screening, while 38% use only manual orchidometry and 11% observation with serial examinations. If significant testicular size discrepancy is identified, 32% immediately intervene surgically, while 59% repeat measurements in 6-12 months. When no discrepancy is identified, 36.6% of practitioners discharge their patients with no follow-up, 22.5% refer to an infertility specialist, and 31% evaluate with semen analysis. Fifty-seven percent of practitioners have never sent patients for semen analysis; only 4% send >50% of patients. Of these, 52% and 27% analyzed semen at 17-18 years and 19-20 years, respectively, and 10% send for semen analysis at <17 years.
  
  
  CONCLUSIONS
  Our survey demonstrates that there does not appear to be a consensus among pediatric urologists managing asymptomatic grade 2 and 3 varicoceles. Better understanding of which adolescent patients with varicoceles will go on to develop male infertility is necessary to identify pediatric patients who could benefit from early intervention.
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Coutinho
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA.
authors.forename: Daryl
authors.initials: D
authors.lastname: McLeod
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA. Electronic address: Kristian.stensland@mssm.edu.
authors.forename: Kristian
authors.initials: K
authors.lastname: Stensland
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology, Kravis Children's Hospital at Mount Sinai, New York, NY, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Stock
mesh_terms: D000293:Adolescent; D002983:Clinical Competence; D019468:Disease Management; D006801:Humans; D008297:Male; D010808:Physical Examination / Q000379:methods*; D010820:Physicians / Q000592:standards*; D011795:Surveys and Questionnaires; D014646:Varicocele / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
keywords: Adolescent; Fertility; Varicocele