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 th e use of color Doppler ultrasound (CDUS) as an objective tool in the assess ment of such patients in a 5-year prospective study for determination of va ricocele size, venous flow patterns, testicular volume, and resistance inde x. A high ligation was performed only when reverse blood flow was demonstra ble in the varicocele during a Valsalva maneuver, and a low approach when t his 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 introduc tion of CDUS (20.5%) (P = 0.004). These results are even more striking when contrasted with published recurrence rates of 12% to 15% (r = 0.015 to 0.0 03). Thus, CDUS proved to be a useful tool in selecting the proper surgical approach for varicocele in adolescence. The incidence of recurrence was si gnificantly reduced following the introduction of this procedure.