Varicocele in childhood: when is surgery performed?
Varicocele is an insidious disease because it does not always give early symptoms.
It is a fairly common condition but fortunately a reversible cause of male infertility. Its frequency in 10-year-old children is 6% and approximately 15% in 13-year-old children. In over 90% it is located on the left and this is due to anatomical reasons.
Varicocele is the dilation of the venous network that drains blood from the testicles. In other words, it is a venous insufficiency, like varicose veins in the legs, that is, a dysfunction of the veins in the scrotum, resulting in the non-channeling of blood from this area to the central circulation.
The result is the inability to enter a sufficient amount of arterial blood into the testicle, due to the fact that the venous blood remains stagnant and pools inside it, thus creating poor conditions for the maturation of sperm.
It is usually discovered by chance by his pediatrician or the child himself. The usual symptoms are a feeling of heaviness in the testicles and mild pain at the end of the day. These symptoms seem to become more intense in the heat.
When palpating the testicle, the impression is given of a soft mass, which has no clear boundaries. It is characteristic that this mass decreases when the patient lies down, while it increases in the upright position and with increasing pressure in the abdomen (when we tighten our abdomen, such as with physical exercise, weight lifting, sports).
The clinical diagnosis is confirmed by ultrasound examination (color triplex).
The treatment is exclusively surgical because it is a clear cause of infertility and sterility in men.
The Pediatric Surgeon will recommend surgery when the following reasons are present:
- Children, in whom documented, by ultrasound examination, there appears to be a delay in testicular development
- Coexisting testicular abnormalities that affect fertility.
- Pathological spermiogram in older adolescents.
- Bilateral palpable varicocele.
- Symptoms
The aim of treatment is to interrupt the circulation of the spermatic veins. There are various techniques, of which microsurgery has the best results.
However, studies from various centers that apply other techniques (e.g. laparoscopic) show similar results. In the microsurgical method, the vessels (veins, arteries and lymphatics) are better identified, thus reducing recurrences to a minimum. The operation is performed under general anesthesia and the patient is discharged the next day.
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