[Treatment of adolescent varicocele: is percutaneous embolization better?]

There are still doubts as to the most suitable criteria when considering surgery as the indication and optimal treatment for adolescent varicocele.

We reviewed the hospital and primary health care histories of patients diagnosed by ultrasound for varicocele over the last 7 years. The data was taken from computerised clinical histories and hard copy back-up material stored and processed in computer format.

We studied 135 cases (mean age 12.8 years). These patients (125) were referred for scrotal swelling or as a result of chance detection, except for 10 patients who reported pain or scrotal asymmetry. Seventy-three underwent surgery and 62 continued as controls over the study period. The surgical indication was significant progressive asymmetry in testicular volume (28 children), high grade varicocele (41) as well as other reasons (4). We undertook percutaneous embolization in 44 patients (with a 66% relapse rate) and laparoscopic section of the spermatic cord with no arterial preservation in 29 (no relapses but 7 post-surgery hydroceles). No testicles were lost. At the end of the study 10 children continued as controls, 34 were discharged after recovery, 56 were referred to urology due to their age group, and 35 were lost to the study.

In the controversy over the treatment of varicocele our experience shows a high degree of relapses after embolization. Section of the spermatic vessels (including the artery) with no lymphatic preservation is highly effective but involves 27% post-op hydroceles, usually self-limiting (only one had later to undergo surgery), with no testicular atrophy or other complications.

We prefer complete laparoscopic section of the spermatic pedicle to embolization but it would be advisable to introduce modifications to avoid post-surgical hydrocele. Embolization must be reserved for patients with one testicle or with bilateral disease. Efforts must be made to communicate more effectively, in order to reduce the high drop-out rate.