Management of paediatric varicocele in Australia and New Zealand: A survey of the Australian and New Zealand association of paediatric surgeons (ANZAPS)

Abstract

PURPOSE: The diagnosis and management of paediatric varicocele remain controversial. We aimed to evaluate current practices in Australia and New Zealand (ANZ). METHODS: An anonymous survey using the online Qualtrics platform (© 2024 Qualtrics), distributed to 114 ANZ active paediatric surgeons and paediatric urologists. Data collected included demographics, diagnostic processes, operative indications and techniques, and post-operative follow-up. Descriptive statistical analysis was conducted. RESULTS: A total of 61 (53 %) responses were collected. The most commonly used diagnostic method was clinical examination with ultrasound (63% of respondents), with 82 % of this group requesting ultrasounds of the testes and abdomen. The principal indications for surgery were testicular volume discrepancies (95 % of respondents) and patient discomfort (97 %). A laparoscopic method was the first-line surgical approach for 51 % of respondents, interventional radiology (IR) for 45 %, and an open approach for 4 %. Mass ligation was the most common laparoscopic technique (74 %), with metallic clips used by 52 %. The majority of respondents favouring IR deferred to interventional radiologists regarding specific approaches. Most respondents (76 %) reported following-up patients for 1-2 years post-operatively. CONCLUSION: We have identified consistent practices among ANZ surgeons regarding the clinical assessment and indications for intervention. Differences are noted with the operative management, with a clear divide between a laparoscopic approach and radiological approach; this may reflect institutional expertise and pathways. This survey forms the basis for collaborative research to standardise the diagnosis and management of paediatric varicocele. LEVEL OF EVIDENCE: Level 5.