Popis: |
Management of the pediatric or adolescent varicocele remains one of the most debated topics in pediatric urology. As the majority of boys present with an asymptomatic varicocele and unknown future fertility, it is challenging to determine who would benefit most from surgical intervention and who can safely be managed with continued observation. Various techniques and modalities may be utilized in the evaluation of the adolescent varicocele. These include direct measurement with physical exam or orchidometry, ultrasound measurement of testicular asymmetry and peak retrograde flow, hormonal evaluation, and semen analysis. As not all adolescents with a varicocele experience testicular growth arrest or subfertility, active surveillance has emerged as a useful strategy. The decision to proceed to surgical intervention is based on documented testicular dysfunction over time. Surgical approaches include open surgery (high retroperitoneal, inguinal, or subinguinal), microsurgical techniques, laparoscopy, and endovascular techniques. Herein, we review the operative procedure, complication rate, and recurrence rate for each approach. Additionally, outcome success rates are assessed from the perspective of semen parameters, testicular volume measurements, hormone production, and paternity. Finally, specific conundrums, such as the pre-adolescent varicocele and the ethics of semen analysis in the adolescent population, are discussed. |