ABSTRACT
Varicocele treatment in adolescents should be considered as a prophilactic procedure. It is known, in-fact, that the venous reflux is responsible for damage to the testis that worsen by time. For this reason patients with grade II or III varicocele and reduced size of the testis must be considered for treatment. A right approach to varicocele should consider the different etiopathogenetic factors. Type I varicocele can be easily treated with embolization of the spermatic vein during the diagnostic phlebographic procedure. For type II and III in which is present an iliac hypertension must be considered a surgical correction with selective ligation of intra- and extrafunicular veins together with a microsurgical spermatico-epigastric anastomosis so to allow a better venous drainage of the testis. The Authors present their experience on 20 selected cases of varicocele treated by selective inguinal veins ligation and microsurgical anastomosis. They underline the importance to search and ligate, using the microscope, when dilated, the external spermatic vein or cremasteric (ligated in 9 cases), the deferential veins (ligated in 18 cases) and the gubernacular veins (ligated in 16 cases). These last can be recognized only after testicular exteriorization. It is also important to avoid lymphatic and testicular artery ligation. The results obtained were good with no recurrence, testicular atrophia or hydrocele.
