Treating symptomatic varicocele

What to consider when investigating and treating varicocele in a teenager

Ethan, aged 14, is brought in by his mother with concerns about swelling in the left testicular region. He is fit and well, plays AFL, and has not had any previous surgery. 

On examination, Ethan weighs 52kg and is 164cm with a BMI of 19kg/m2 (50th centile).