Testicular Criteria as an Indicator for Surgical Necessity in Stage 2, 3, 4 Varicocele in Children and Adolescents

Mohamed Saif Eldin Mahmoud | Ahmed Mohammed Mostafa | Refaat Ibrahim El-Badawy | Yasser Ashoor Mohamed | Mohamed Salah Eldin Abd El Baki

Abstract: Background: Pediatric varicoceles are common, affecting up to 15% of male children and adolescents. There is controversy surrounding the surgical management of varicoceles in the pediatric population. Aim of the work: To identify a testicular criteria for surgical necessity in stage 2, 3, 4 varicoceles in children and adolescents. Patients and Methods: This study involved thirty patients with varicocele (from 10 to 16 years old), 25 (83.3%) patients managed by conservative treatment while 5 (16.7%) patients needed surgical varicocelectomy due to grade 3 refluxing varicocele. Testicular measurements were assessed by scrotal ultrasound, and the formula length ? width ? height ? 0.52 was used to calculate testes volume in cubic centimeters. Patient management was reviewed and evaluated for clinical varicocele grade, ultrasound-assessed testicular volume at initial diagnosis and change over time, and need for surgical intervention. Results: In our study, 25 (83.3%) patients managed by conservative treatment while 5 (16.7%) patients needed surgical varicocelectomy due to grade 3 refluxing varicocele. Considering follow up of volume changes in patients with varicocelectomy and conservative treatment at 3 months, 4 (80%) and 22 (88%) patients have volume greater than 20, respectively. At 6 months, 2 (40%) and 20 (77.3%) patients have volume greater than 20, respectively. However, at 12 months, 17 (76%) patients with conservative treatment only have volume greater than 20. There was significant difference between patients with varicocelectomy and conservative treatment at 6 and 12 months (p <0.001). Regarding outcome, all patients improved without complications. in patients managed by Conservative treatment, improvement occurred in 6 (24%) cases while surgical interference needed in 19 (76%) patients without complications in all cases. Conclusion: Early evaluation and timing intervention is very important in pediatric varicocele. The majority of cases who managed by conservative treatment needed for varicocelectomy to avoid testicular injury and future infertility.

Keywords: Varicocele, Testicular Criteria, varicocelectomy

Edition: Volume 10 Issue 12, December 2021,

Pages: 1222 - 1225