A 13-year-old boy is found to have a left-sided varicocele on routine examination. The varicocele is grade III (visible through the scrotal skin), and the left testis is 10 mL while the right testis is 14 mL. He is asymptomatic. Which of the following is the most appropriate next step?
- A Observation with annual follow-up
- B Scrotal ultrasound with Doppler
- C Surgical repair (varicocelectomy) due to testicular size discrepancy ✓
- D Semen analysis
Correct answer: C. Surgical repair (varicocelectomy) due to testicular size discrepancy
Explanation
In adolescents, surgical repair of varicocele is indicated when there is a testicular size discrepancy of more than 2 mL (or >10-20% volume difference) between the affected and unaffected testis, indicating impaired testicular growth. Grade III varicocele with documented asymmetry meets surgical criteria. Observation is appropriate for smaller varicoceles without asymmetry. Semen analysis is difficult to interpret in adolescents and is not the primary decision tool. Ultrasound confirms the diagnosis but does not change management when clinical findings are clear.
Reference: Campbell-Walsh-Wein Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.