title: Diagnostic and management approaches to pediatric and adolescent varicocele: a survey of pediatric urologists.
abstract: OBJECTIVE
  To assess current diagnosis and management of adolescent varicoceles by pediatric urologists.
  
  
  METHODS
  Online questionnaires assessing diagnosis and management approaches to pediatric and adolescent varicocele were distributed electronically to a national listing of pediatric urologists.
  
  
  RESULTS
  Of 242 pediatric urologists surveyed, 131 (54%) responded to the survey. Only 3% of respondents operate on varicoceles at diagnosis, whereas 14% observe, and 83% base treatment on further indications. Varicocelectomy is most commonly performed for decreased ipsilateral testicular size (96%), testicular pain (79%), and altered semen analysis parameters (39%), with the mean age for varicocelectomy being 12.5 ± 3.1 years. Most physicians use ultrasonography (US) or Doppler US to aid in the diagnosis of varicoceles, and half of physicians would not repair incidental findings of varicocele on US. In an otherwise asymptomatic patient with a varicocele, 28% of physicians would consider varicocelectomy depending on varicocele grade. The most common surgical approaches to varicocelectomy were laparascopic (38%), subinguinal microsurgical (28%), inguinal (14%), and retroperitoneal (13%), and most physicians used loupes for these procedures. The most common complication experienced after adolescent varicocelectomy was hydrocele followed by hematoma, testicular atrophy, chronic pain, paresthesia, and varicocele recurrence or persistence. Only 58% of physicians had follow-up data on their varicocele patients, and 89% did not know whether patients developed infertility. Of patients who developed infertility, 39% had undergone varicocele repair.
  
  
  CONCLUSIONS
  Significant variation in diagnostic approaches, decision to treat, and operative approaches exists among pediatric urologists, and combined with a dearth of objective data, limits development of management guidelines.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Pastuszak
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Varun
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Anup
authors.initials: A
authors.lastname: Shah
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX; Baylor College of Medicine, Houston, TX; Division of Urology, Texas Children's Hospital, Houston, TX. Electronic address: drroth@texaschildrens.org.
authors.forename: David R
authors.initials: DR
authors.lastname: Roth
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014572:Urology; D014646:Varicocele / Q000175:diagnosis* / Q000628:therapy*