In Reply.— Until objective guidelines are established, I would be opposed to a more aggressive approach to the adolescent varicocele because not all of these children are at risk for future problems. At the present time, we are primarily concerned about individuals with a large varicocele, particularly when there is volume loss of the testis ipsilateral to the varicocele. Surgical ligation of a large varicocele is routinely performed as a brief outpatient procedure with the aid of optical magnification to facilitate ligation of the multiple venous collaterals so often found in individuals with a large vanicocele.