Background. Microsurgical varicocele repair has become the gold standard in adults and only a few
reports are available in children and adolescents. We present our experience with this method and
concentrate on the technical performance, complications and development of testicular size.
Methods and Results. 47 patients aged 11 to 18 years (x-15.4) underwent microsurgical subinguinal
repair for varicocele grade II.–III. Operation was indicated because of hypoplastic testicle (expressed by
the atrophy index > 25 %), pain, large varicocele or parents preference. The patients were examined
clinically, by ultrasound including the Doppler study; hormonal examination was added using the
gonadoreline stimulation test. Microscope has been used to identify the internal spermatic artery, to
dissect the artery from the complex of small surrounding veins and to identify the lymphatic vessels. We
found 3 recurrences in 46 patients (6 %) operated for primary varicocele. The atrophy index decreased
from x - 19.7 to 12.7 %, without any association with pubertal stage. Atrophy of the testis was not found
in any patient. Hydrocele was detected in one patient (2.1 %), and left testicular hypertrophy also in one
patient (2.1 %).
Conclucions. Microsurgical subinguinal varicocelectomy is a safe and efficacious method in children
and adolescents; using the microscopic dissection, the internal spermatic artery and accompanying
lymphatic vessels are safely spared.
varicocele, children and adolescents, microsurgical varicocelectomy, subinguinal