Varicocele is the condition in which the internal spermatic veins of the pampiniform plexus are abnormally dilated and tortuous, usually but not exclusively on the left side. In children, the condition is related to Tanner stage, rarely seen before the age of 10, peaking at Tanner stage III. In late puberty, a 15% prevalence equals what is observed in the adult population. Most varicoceles are diagnosed incidentally on routine clinical examination and are graded on the basis of size and prominence with regard to positive abdominal pressure into three clinical grades; grade I is only palpable on Valsalva; grade II is easily palpable without straining and grade III is visible. Indications for management in the adolescent population and in the absence of semen analysis are pain and testicular hypotrophy, which is a de facto proxy measure for testicular dysfunction. Varicocelectomy by open classical procedures, laparoscopically, microsurgical technique or sclerotherapy has been shown to offer clear advantages on reducing testicular size discrepancy with calculated average catch-up ratios of between 60 and 100%. The highest success rates and lowest complication/recurrence rates have been reported after microsurgical technique.