Controversies in the laparoscopic treatment of varicocele in the pediatric population

At present, treatment of varicocele is still controversial in adolescents for at least three reasons. Firstly, the long-term outcome of treatment is not known in the absence of spermiogram support and in terms of long-term follow-up. Secondly, it is still uncertain which is the best type of operation for children/adolescents. Thirdly, the principle that if a technique is designed for adults, it can also be safely performed in adolescents cannot be applied. A recent systematic literature review and meta-analysis demonstrated that open and laparoscopic techniques appear to yield better results with a microsurgical approach compared with laparoscopy. However, laparoscopic techniques that preserve the lymphatic vessels appear to have a clear advantage by preventing postoperative hydrocele. At present, the evaluation and choice of treatment for adolescent varicocele patients are based not on objective fertility criteria (paternity) but on indirect evidence that testicular function or spermatogenesis and thus ultimately also fertility may be compromised. In the absence of sufficient data regarding the treatment of varicocele at a pediatric age, the choice of the technique appears to depend largely on the experience and preferences of the surgeon rather than on a shared option.