IDIOPATHIC VARICOCELE IN CHILDREN AND ADOLESCENTS - WHICH THERAPEUTICCHOICE

61 children were studied and treated between January 1986 and Septembe r 1993 for idiopathic varicocele. The aim of our study was to evaluate the advantages and disadvantages of the different techniques and to s how the progression to a greater efficacy. The mean age at the time of therapy was 14 years, ranging from 7 to 16 years. All children presen ting with pain or testicular asymmetry were treated. Four asymptomatic children were followed for 2 years before treatment, 36 children were treated by surgical ligature via the inguinal approach; 8 with a rese ction of the varicose veins as far as the tunica vaginalis. 14 childre n were treated by percutaneous sclerotherapy including 1 patient follo wing unsuccessful classical surgical treatment. 12 children were treat ed by surgical inguinal ligature associated with peroperative phlebogr aphy and thrombosis. 56 children were reviewed postoperatively over a period which varied from 2 months to 4 years (5 lost to follow-up). Fo r the 36 classical ligatures: 25 good results, but 9 hydroceles (5 out 8 varicose resections): 70 % good results. 7 failures and 4 lost to f ollow-up. For the 14 percutaneous sclerotherapy: 4 technical failures (impossibility to catheterize the spermatic vein): 10 good results. Fo r the 12 ligatures with peroperative phlebography and thrombosis: 11 g ood results and 1 lost to follow-up. All the above procedures were car ried out at our out-patient clinic. The therapeutic choice will theref ore have to take into consideration a procedure which produces the low est morbidity rate and proves to be the most effective. The associatio n of surgical ligature, phlebography and thrombosis meets these requir ements.