Treatment of pediatric patients with varicocele is based on the desire to prevent testicular dysfunction and possible infertility that may become irreversible in adults. The authors reviewed their experience with retrograde percutaneous sclerotherapy (RPS) via a trans-femoral approach to assess its results in children. A retrospective study was conducted, including all the children admitted between 2000 and 2004 who underwent RPS with at least 24 months follow-up (FU). The indication for treatment was grade II and III varicocele (Dubin-Amelar classification), confirmed by Doppler US. Three per cent sodium tetradecyl sulfate was the sclerosing agent. FU included Doppler US 1 month after the procedure and then yearly for at least 2 years. Eighty-six children (mean age 13.8 years) underwent phlebography and, when feasible, RPS. Varicocele was grade II in 49 cases and grade III in 37. RPS was feasible in 72 (84%) children because of unfavourable anatomic features of the left spermatic vein. RPS was successful in 66 (92%) out of 72 treated children. Median FU was 29 months. During FU, five (8%) patients relapsed. RPS of varicocele is a simple and effective treatment. A minimum of 2 years FU is recommended, as a few cured cases may relapse during this period.