The adolescent varicocele: to treat or not to treat

Whether to treat adolescents with varicocele is controversial because over 80% of adult varicoceles are not associated with infertility. Most physicians agree that treating all adolescents with varicocele and subjecting boys to unnecessary surgery is inappropriate, costly, and not without ethical considerations. Waiting until patients present as adults with potentially irreversible infertility, however, is equally unacceptable. Pediatricians and urologists must determine which adolescents are at greatest risk for future fertility problems and warrant early intervention. This article reviews the current literature surrounding adolescent varicocele and offers recommendations for identifying individuals who would most benefit from treatment.