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

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 less than0.001). 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.