Adolescent varicocele, a Gordian knot: A comprehensive review of clinical perspectives and future directions

Table 1 Tanner stages of male pubertal development

Stage	Pubic hair scale	Male external genitalia scale
I	No hair	Testicular volume < 4 mL or long axis < 2.5 cm
II	Downy hair	4-8 mL (or 2.5-3.3 cm long), 1st pubertal sign in males
III	Scant terminal hair	9-12 mL (or 3.4-4.0 cm long)
IV	Terminal hair that fills the entire triangle overlying the pubic region	15-20 mL (or 4.1-4.5 cm long)
V	Terminal hair that extends beyond the inguinal crease onto the thigh	> 20 mL (or > 4.5 cm long)

Table 2 Sarteschi/Liguori ultrasonographic classifications of varicoceles

Grades	Reflux	Engorged vessels/varicosities	Relationships of the varicosities with the testis	Reflux or varicosities in supine/standing position with/without Valsalva maneuver	Testicular size
I	Inguinal reflux present	Non-engorged vessels	-	Reflux only during Valsalva while standing	Normal
II	Reflux present	Varicosities present	Supra-testicular varicosities	Reflux only during Valsalva while standing	Normal
III	Reflux present	Varicosities present	Peri-testicular varicosities	Reflux while standing and during Valsalva	Normal
IV	Reflux present at rest	Varicosities present	-	Reflux at rest, increasing during Valsalva. Enlarged vessels in supine and standing positions increasing caliber during Valsalva	Possible testicular hypotrophy
V	Reflux present at rest	Varicosities present	Intratesticular varices may be present	Reflux at rest, not increasing during Valsalva. Enlarged vessels in supine and standing positions	Testicular hypotrophy