Criteria for surgical treatment of left-sided varicocele in children

BACKGROUND: Determining clear indications for surgical correction of varicocele in pediatric patients remains a relevant clinical problem.

AIM: The work aimed to identify parameters serving as indications for surgical treatment of varicocele in children.

METHODS: A prospective study was conducted on 86 patients diagnosed with left-sided varicocele. The observation period was from September 2024 to April 2025. Patients were divided into two groups: group 1 included 54 (62.8%) surgically treated children; group 2 comprised 32 (37.2%) adolescents under outpatient follow-up. The study was conducted at the Irkutsk City Ivano-Matreninskaya Children’s Clinical Hospital.

RESULTS: The median age of children in both groups was 15 [14; 16] years. The median body mass index was 19.4 [17.6; 21.5] kg/m²; underweight was identified in 30 (34.9%) adolescents. The cause of varicocele was aorto-mesenteric compression of the left renal vein in 65.1% of cases. Complaints of pain or discomfort in the left hemiscrotum were reported by 20 (23.3%) adolescents. Left testicular hypotrophy was found in 22 (40.7%) children undergoing surgery and in 4 (12.5%) patients under follow-up (p = 0.03). Differences between groups were observed in the diameter of pampiniform plexus veins (p = 0.00001). Reflux in the pampiniform plexus veins during stress tests was detected in 30 (55.5%) patients in group 1 and in 6 (18.7%) patients in group 2 (p = 0.0046). Increased flow velocity >30 cm/s occurred in 44.4% of surgically treated cases and 18.7% of those under follow-up (p = 0.048). Logistic regression analysis identified five combined factors defining precise indications for surgical correction of varicocele in children: scrotal pain or discomfort complaints (β = 0.251 ± 0.087; t(77) = 2.87; p = 0.00532); resistance index of the left testicular artery <0.5 or >0.6 (β = –0.368 ± 0.078; t(77) = –4.72; p = 0.00001); left testicular volume ≥20% smaller than the right (β = 0.276 ± 0.091; t(77) = 3.02; p = 0.00345); pampiniform plexus vein diameter >3.9 mm under stress tests (β = 0.192 ± 0.058; t(77) = 3.26; p = 0.00167); compression of the left renal vein at the aorto-mesenteric junction >8 points (β = –0.502 ± 0.141; t(77) = –3.55; p = 0.00066).

CONCLUSION: Decision-making regarding surgical treatment of varicocele requires a comprehensive and personalized approach to the examination of the child. The study results provide precise criteria for surgical correction of scrotal varicose veins in adolescents, including physical examination, patient complaints, and mandatory ultrasound with testicular vessel Doppler imaging.