Author : Mahdi Albassam, Salim
The Medical Journal of Basrah University,
Volume 28, Issue 1, Pages 18-22
Aim: To determine the incidence of congenital varicocele in pediatric and prepubertal age groups, and to compare
between two surgical approaches with different procedures.
Methods: In march and April 2001 seven thousands five hundred and forty three pupils in twelve primary schools
were examined for detection of congenital varicocele, the pupils were divided into two groups according to age; group
one between age of 6-12 years, group two between age of 13-16 years. The positive cases in the two groups were
classified into two batches: symptomatic and non-symptomatic; the silent cases were scheduled for expectant
management. The symptomatic cases were randomly divided into two groups for surgical options by open
varicocelectomy, the first one through inguinal approach with high ligation of spermatic vein, the second through
retroperitoneal route with ligation of both spermatic artery and vein.
Results: The number of cases of positive varicocele was 16(0.4%) in pediatric age (6-12 years). This figure increased
to 102 (2.58%) in prepubertal age (13-16 years). In the positive cases, we found an increase in number with age
especially after age of eight. The symptomatic cases were registered only in prepubertal age and varicocele established
clinically as age advanced and all positive cases in pediatric age group were silent. The rate of cure in cases treated by
venoarterial ligation was 29 cases (90.5%), while it was 23 cases (74%) in those managed by ligation of vein only.
The recurrence rate after venoarterial ligation was one case (3%) and after vein ligation only was 3 cases (9.6%). No
reduction in size of testes in the batch treated by venoarterial ligation. The incidence of Hydrocele in the cases treated
by vein ligation was slightly less than that after venoarterial ligation. The improvement in size of testes is better after
venoarterial ligation but the numbers of reduction in the size of varicocele were more in cases treated by vein ligation
only. Scrotal hematomas were recorded only after vein ligation. Hospital stay was shorter in cases treated by
venoarterial ligation through retroperitoneal route. Wound infection occurred more after vein ligation.
Conclusion: In this study we concluded that it is preferable to leave children with silent varicocele for expectant
management. The option of spermatic venoarterial ligation for management of varicocele is safe and more rewarding
regarding rate of cure and testes volume improvement.