[Varicocele in children and adolescents-conservative vs. surgical treatment?]

The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8-14%. Up to 15% of patients with varicocele have impaired fertility. The indication for therapy of varicocele is still controversially discussed. In clinical trials testicular volume, volume difference, semen quality, fertility, hormones and pain have been investigated. The results are very heterogeneous for all parameters, so that the evidence level of recommendations for therapy of varicocele is very low. Nevertheless, the EAU guidelines recommend therapy of varicocele in children and young adults in case of small testis (volume difference >2 ml or 20%), additional cryptorchism, bilateral palpable varicoceles, symptomatic varicoceles and in case of pathological semen (in older boys). Microsurgical inguinal and laparoscopic procedures with preservation of lymph vessels have the best success and lowest complication rates.