**8. Conclusion**

Given the current status of the literature, we can confidently state that, from a scientific perspective, the treatment of varicocele in the pediatric population is a typical example of epistemic uncertainty. While active treatment of varicocele in the pediatric and adolescent population is controversial, it is clear that some untreated patients will suffer symptoms later in life, while overtreatment remains a concern for this large and vulnerable population [61].

One of the most complete studies on the current trends regarding varicocele is a scientometric study undertaken in 2022, performed by analysis of data retrieved from the Scopus database presented by Agarwal et al. [62]. They considered 1943 original human studies on varicocele, published between 1988 and 2020. The authors found that studies of adolescents were underrepresented compared with studies of adults. Published reports on varicocele in adolescents included 355 (n = 18.3%) articles, with the highest yearly trend of publications in 2013 (n = 21). All of the remaining manuscripts (n = 1588; 81.7%) focused on adults. Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies, and studies focused on etiological and risk factors. Varicocele surgery was investigated more than non-surgical approaches. Furthermore, adolescent varicoceles are usually diagnosed incidentally, and the presentation of symptomatic cases may differ during pubertal development. In addition, the collection of semen samples from post-pubertal patients is not always feasible, and there are no reference standards for the interpretation of semen analysis in this population. The study has shown a higher interest by scholars (88.9%) in choosing surgical rather
