Varicocele in Adolescents Guidelines

Updated: Sep 22, 2022
  • Author: James M Elmore, MD; Chief Editor: Marc Cendron, MD  more...
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EAU Guidelines for Pediatric Varicocele

In 2022, the European Society for Paediatric Urology (ESPU) published the following recommendations for management of varicocele in children and adolescents [26] :

  • Examine varicocele in the standing position and classify into three grades
  • Use scrotal ultrasonography (US) to detect venous reflux without Valsalva maneuver in the supine and upright position and to discriminate testicular hypoplasia
  • In all prepubertal boys with a varicocele and in all isolated right varicoceles, perform standard renal US to exclude a retroperitonal mass
  • Inform caregivers and patients and offer surgery for (1) varicocele associated with a persistent small testis (size difference > 2 mL or 20%), (2) varicocele associated with additional testicular condition affecting fertility (cryptorchidism, history of torsion, trauma), (3) varicocele associated with pathologic sperm quality (in older adolescents), or (4) symptomatic varicocele
  • Use some form of optical magnification (microscopic or laparoscopic) for surgical ligation
  • Use lymphatic-sparing varicocelectomy to prevent hydrocele formation and testicular hypertrophy