Varicocele: A multidisciplinary approach in children and adolescents

Purpose: To minimize varicocele treatment in children and adolescents a mul tidisciplinary approach that includes surgery and operative radiology has b een used at our institution since 1991. We present; our results during this 7-year period. Materials and Methods: From January 1991 to December 1997 we examined 477 p atients 4 years 5 months to 25 years 4 months old (mean age 13 years 3 mont hs) with varicocele, of whom 367 (396 varicoceles) required treatment. Perc utaneous sclero-embolization was suggested as the primary treatment of choi ce in all cases, while surgery was reserved for select cases. A total of 36 6 cases followed at least 6 months (mean 1 year) were entered into this stu dy. Results: Only 7.1% of the patients or families preferred surgery. In 47 pat ients sclero-embolization was not possible due to technical problems or vas cular anomalies. Sclero-embolization was successful in 79.4% of 277 patient s, and retroperitoneal ligation was successful in 88.7% of 124. Since 1995 ligation of the whole spermatic bundle above the vas deferens has been pref erred, and only 1 recurrence has been observed in 60 cases. Conclusions: Percutaneous sclero-embolization is a minimally invasive treat ment of varicocele that is feasible in. children and adolescents. Most pati ents prefer this therapy, although it is not as safe as surgery. When open surgery is required, complete ligation of the whole vascular pedicle above the vas deferens offers excellent success.