Based on current available r and omized controlled trials , there is low to moderate level of evidence that radiological or surgical treatment of adolescent varicocele is associated with improved testicular size/growth and sperm concentration .
BACKGROUND The prevalence of varicoceles is as high as 15 % in children and adolescents .
Optimal management of varicoceles has not been consoli date d. Options include observation , radiological intervention , or surgical varicocelectomy .
OBJECTIVE Herein , we aim to assess the outcomes of radiological and surgical interventions for varicocele in children and adolescents evaluated by RCTs .
Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns.
OBJECTIVE To investigate different varicocele hemodynamic patterns ( shunt type vs. stop type ) as predictors of new-onset testicular hypotrophy or recurrence after varicocelectomy . DESIGN Prospect i ve clinical study . SETTING Department of pediatric urology , children 's hospital medical center . PATIENT(S ) Seventy-four children and adolescents with varicocele . INTERVENTION(S ) Based on ultrasound findings , patients were classified into shunt-type or stop-type varicocele groups . All patients with stop-type varicocele and testicular volume discrepancy of ≥20 % underwent retroperitoneal varicocelectomy and internal spermatic vein ligation .  Patients with shunt-type varicocele and ≥20 % testicular asymmetry were r and omly divided to undergo either retroperitoneal varicocelectomy ( ligation of internal spermatic vein ) or inguinal varicocelectomy with ligation of both internal and external spermatic veins . Patients with testicular volume discrepancy of < 20 % were put on conservative management . MAIN OUTCOME MEASURE(S ) Occurrence of new-onset asymmetry among untreated patients and recurrence rate among operated patients . RESULT ( S ) Patients with shunt-type varicocele who did not undergo surgery revealed a higher risk of developing asymmetry during follow-up ( odds ratio 10.5 ) . Ligation of both internal and external spermatic veins in shunt-type patients was associated with significantly decreased rate of recurrence ( 6.3 % ) compared with retroperitoneal approach ( 30.8 % ) . CONCLUSION ( S ) Shunt-type varicocele is associated with a higher risk of testicular hypotrophy among untreated patients . In addition , recurrence rate in shunt-type patients who underwent inguinal varicocelectomy was lower compared with retroperitoneal approach
Based on current available r and omized controlled trials , there is low to moderate level of evidence that radiological or surgical treatment of adolescent varicocele is associated with improved testicular size/growth and sperm concentration .
BACKGROUND The prevalence of varicoceles is as high as 15 % in children and adolescents .
Optimal management of varicoceles has not been consoli date d. Options include observation , radiological intervention , or surgical varicocelectomy .
OBJECTIVE Herein , we aim to assess the outcomes of radiological and surgical interventions for varicocele in children and adolescents evaluated by RCTs .