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Abstract：
Pediatric varicocele has an overall prevalence of 15%, being more frequent as puberty begins. It can damage testicular function, interfering with Sertoli cell proliferation and hormone secretion, testicular growth and spermatogenesis. Proper management has a pivotal role for future fertility preservation. The aim of this review was to discuss the diagnosis, management and treatment of childhood and adolescent varicocele from an endocrinologic perspective, illustrating the current evidence of the European Society of Pediatric Urology (ESPU), the European Association of Urology (EAU), the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) scientific societies. According to the ASRM/ESPU/AUA practice committee, the treatment of adolescent varicocele is indicated in the case of decreased testicular volume or sperm abnormalities, while it is contraindicated in subclinical varicocele. The recent EAS/ESPU meta-analysis reports that moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration increase. No specific phenotype in terms of testicular volume cut-off or peak retrograde flow (PRF) is indicated. Based on current evidence, we suggest that conservative management may be suggested in patients with PRF < 30 cm/s, testicular asymmetry < 10% and no evidence of sperm and hormonal abnormalities. In patients with 10-20% testicular volume asymmetry or 30 < PRF ≤ 38 cm/s or sperm abnormalities, careful follow-up may ensue. In the case of absent catch-up growth or sperm recovery, varicocele repair should be suggested. Finally, treatment can be proposed at the initial consultation in painful varicocele, testicular volume asymmetry ≥ 20%, PRF > 38 cm/s, infertility and failure of testicular development.
摘要：
小儿精索静脉曲张的总体患病率为15％，随着青春期的开始变得更加频繁。它会损害睾丸功能，干扰支持细胞增殖和激素分泌，睾丸生长和精子发生。适当的管理对于未来的生育力保护具有关键作用。这篇综述的目的是讨论诊断，从内分泌角度管理和治疗儿童和青少年精索静脉曲张，说明欧洲小儿泌尿外科学会（ESPU）的当前证据，欧洲泌尿外科协会（EAU），美国泌尿外科协会（AUA）和美国生殖医学学会（ASRM）科学学会。根据ASRM/ESPU/AUA实践委员会的说法，在睾丸体积减少或精子异常的情况下，需要治疗青少年精索静脉曲张，虽然它在亚临床精索静脉曲张中是禁忌的。最近的EAS/ESPU荟萃分析报告，在睾丸体积和精子浓度增加方面，儿童和青少年精索静脉曲张治疗的益处存在中度证据。在睾丸体积截止值或峰值逆行流量（PRF）方面没有特定的表型。根据目前的证据,我们建议对PRF<30cm/s的患者建议保守治疗，睾丸不对称<10％，没有精子和激素异常的证据。在10-20％睾丸体积不对称或3038cm/s,不育和睾丸发育失败。
