Microsurgical treatment of varicocele in children

The varicocele is a common cause of adult male infertility, but surgical treatment in adolescence still remains controversial. Many data suggest that early recognition and correction of a varicocele may prevent testicular damage and sterility. The argument that infertility does not necessarily result in each case is probably not relevant due to uncertainty involved in an individual case. Changes similar to those observed in infertile adults occur in the affected testicle in adolescents with varicocele. High ligation of the spermatic veins is associated with a 20% recurrence rate. Twenty-five children (mean age 12 years 5 months) underwent microsurgical treatment for a left-sided varicocele. All had antegrade phlebography under general anesthesia to distinguish the type of varicocele and determine the proper surgical approach. Twenty (80%) patients had type 1, 2 (8%) type 2, and 3 (12%) had a third type. All were treated using Belgrano's technique, which seems to allow anatomic-physiologic venous return from the testis. The mean postoperative hospitalization was 4 days and the mean follow-up time 17 months. Begrano's technique is a complete, easy and esthetically effective procedure for treating varicocele in childhood. It is also advisable to employ phlebography in patients treated by the most common surgical approach to avoid recurrences. These findings encourage early surgical treatment, which in our experience was always effective.