Decision-making in pediatric varicocele surgery: use of color Doppler ultrasound

Although varicoceles are common in adolescence, the indications for surgery as well as the procedure of choice are controversial. We have evaluated the use of color Doppler ultrasound (CDUS) as an objective tool in the assessment of such patients in a 5-year prospective study for determination of varicocele size, venous flow patterns, testicular volume, and resistance index. A high ligation was performed only when reverse blood flow was demonstrable in the varicocele during a Valsalva maneuver, and a low approach when this finding was absent. Twenty-six boys underwent low ligation and 53 high ligation based on the findings of CDUS. The incidence of recurrence (3.8%) was lower than that encountered by the same surgical team prior to introduction of CDUS (20.5%) (P = 0.004). These results are even more striking when contrasted with published recurrence rates of 12% to 15% (P = 0.015 to 0.003). Thus, CDUS proved to be a useful tool in selecting the proper surgical approach for varicocele in adolescence. The incidence of recurrence was significantly reduced following the introduction of this procedure.