Surgical treatment of varicocele in children

Fifty boys aged 6 to 14 years underwent surgery for left varicocele. Thirty-four patients underwent preoperative retrograde left renal venography and pressure measurements of both renal veins and inferior vena cava. In all patients an intraoperative antegrade renal venography was performed via the internal spermatic vein. The preoperative venographic studies revealed renospermatic reflux in all patients examined. The intraoperative studies demonstrated impaired renal venous drainage in 38 patients (Group A) and normal venous return in 12 patients (Group B). Manometric studies revealed increased left renal venous pressure in Group A. In view of these anatomical and functional disorders, our preferred procedure is a retroperitoneal ligation and excision of the left internal spermatic vein. The retroperitoneum was thoroughly explored and all the visible collaterals of the internal spermatic vein ligated. Forty boys were followed for 1 to 5 years; the varicocele was completely resolved in 35 of them. Five patients had recurrent varicocele; recurrence was observed only in patients with increased left renal vein pressure (Group A).