Varicocele occur in about 15% of all adolescents. These authors searched Medline, Embase and a number of platforms reporting on varicoses in children and adolescents, including only randomised controlled trials with patients under 21 years. After an initial 198 studies were identified, only nine eligible studies were included to look at changes in testicular size, semen analysis parameters, and events and failures with no treatment, surgical treatment or radiological treatment. Five studies were pooled into a meta-analysis whereas four could not be included because of too much heterogeneity. In three of the nine studies varicoceles were of grade 2 or 3, in one of nine they were grade 3 only and in the others the grade was unclear. The risk of bias was assessed. The parameters looked at were changes in testicular volume (using ultrasound scan and / or orchiometer), semen parameters, recurrence, hydrocele, operating time and length of stay. The authors conclude that there is intermediate to low level of evidence to support radiological or surgical interventions for varicocele in children or adolescents to improve testicular volume or semen analysis. Long-term effects on fertility could not be assessed.
