Do you recommend surgical repair for asymptomatic adolescents with a grade 1 varicocele and normal ipsilateral testicular volume on ultrasound?

No.

I intervene surgically for refractory pain that limits daily or athletic activities after conservative management has failed, OR, if there is a > 20% size discrepancy between the testes (the child is Tanner 5, and the likelihood of differential testis growth being explained by incomplete puberty...