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Patel S, Ahmed I, Thomson B. Oh nuts, they've got a pelvic kidney - a tricky testicular vein embolisation. BJR Case Rep 2023; 9:20220130. [PMID: 37928700 PMCID: PMC10621584 DOI: 10.1259/bjrcr.20220130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Testicular vein embolisation for varicocele is a common interventional procedure performed in predominantly young, healthy males. Cross-sectional imaging is rarely performed for treatment planning and is often not available. In this case report, we describe a case of testicular vein embolisation in an ipsilateral pelvic kidney where cross-sectional imaging aided treatment planning resulting in successful embolisation.
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Affiliation(s)
- Sajal Patel
- Interventional Radiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Irfan Ahmed
- Interventional Radiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Benedict Thomson
- Interventional Radiology Department, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
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2
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CIRSE Standards of Practice on Varicocele Embolisation. Cardiovasc Intervent Radiol 2023; 46:19-34. [PMID: 36380154 DOI: 10.1007/s00270-022-03293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous embolisation is an effective, minimally invasive means of treating a variety of benign and malignant lesions and has been successfully used to treat varicoceles since the late 1970s, with refined and expanded techniques and tools currently offering excellent outcomes for varicocele embolisation. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team (MDT) and will define the standards required for the performance of each modality, as well as their advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of percutaneous varicocele embolisation. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in embolisation of male varicoceles. The writing group reviewed the existing literature on varicocele embolisation, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects published from 2006 to 2021. The final recommendations were formulated through consensus. CONCLUSION Embolisation has an established role in the successful management of male varicoceles. This Standards of Practice document provides up-to-date recommendations for the safe performance of varicocele embolisation.
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3
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Fallara G, Tang S, Pang KH, Pozzi E, Belladelli F, Schifano N, Capogrosso P, Alnajjar HM, Montorsi F, Salonia A, Castiglione F, Muneer A. Treatment of Persistent or Recurrent Varicoceles: A Systematic Review. Eur Urol Focus 2022:S2405-4569(22)00250-4. [DOI: 10.1016/j.euf.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
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4
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Feng R, Jiang J, Cheng D, Lu K. Clinical efficacy comparison of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in primary varicocele patients. Andrologia 2022; 54:e14530. [PMID: 35801615 DOI: 10.1111/and.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/19/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
Varicocele is a more common male genitourinary system disease with sperm quality dysfunction or discomfort. This study was aimed to compare the clinical efficacy of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in treating primary varicocele. Total of 59 patients with primary varicocele receiving a 3-month postoperative follow-up were included to analyse their biochemical parameters and clinical outcomes, including the operative time, hospitalization time, postoperative recurrence rates, and complication rate. Nineteen patients were treated with sclerosing embolization with 3% polidocanol (SE group), while 40 patients were treated with microsurgical subinguinal varicocelectomy (MSV group). For the SE group, 17 patients were treated on the left side, and two patients have treated on both without recurrences and complications during the follow-up period. For the MSV group, three patients were treated bilaterally, and 36 patients were treated separately on the left side with a total 5% recurrence rate and 10% complication rate. The duration of surgery and the hospitalization time of the SE group (46.2 ± 9.79 min and 2.53 ± 0.90 days, respectively) are significantly lower than MSV group (100.5 ± 13.76 min and 3.6 ± 1.58 days, respectively), p < 0.05. The total sperm count at 3 months was significantly higher in the SE group than in the MSV group (p < 0.05). In summary, sclerosing embolization is more effective for varicocele in improving sperm quality, shortening recovery time, and reducing recurrence rates and complications.
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Affiliation(s)
- Rui Feng
- Interventional Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Jingsong Jiang
- Vascular Surgery Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Dexin Cheng
- Interventional Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Kaiping Lu
- Vascular Surgery Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
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5
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Boeri L, Fulgheri I, Cristina M, Biondetti P, Rossi S, Grimaldi E, Lucignani G, Gadda F, Ierardi AM, Salonia A, Viganò P, Somigliana E, Carrafiello G, Montanari E. Varicocele embolization with sclerosing agents leads to lower radiation exposure and procedural costs than coils: Data from a real-life before and after study. Andrology 2022; 10:694-701. [PMID: 35179316 PMCID: PMC9306872 DOI: 10.1111/andr.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
Abstract
Objectives To investigate clinical outcomes, radiation exposure and procedural costs associated with percutaneous varicocoele embolization using coils and sclerosing agents (SAs) in a cohort of young‐adult men. Materials and methods Data from consecutive men treated with percutaneous varicocoele embolization using coils and SA between 2017 and 2021 were analyzed. The allocation was based on a change of policy occurred in June 2020 with the substitution of coils with SA (before and after study). Semen analysis values were based on 2010 WHO reference criteria. Anatomic variants of gonadal veins were categorized according to Jargiello et al. Intraoperative radiation dose and procedural costs were collected for each patient. Descriptive statistics and linear regression models were used to describe the association between clinical parameters with procedural costs and radiation exposure. Results One hundred sixteen men were included, of whom 76 (65.5%) received coils, and 40 (34.5%) received SA. Baseline characteristics of the two study groups did not differ. A type 3 Jargiello anatomic variation of left gonadal vein was found in 45.7% of cases. Radiation dose was lower in the SA group as compared to the coils one (13.2 [7–43] vs. 19.8 [12–57] Gy/cm2; p < 0.001). Similarly, procedural costs were lower for the SA group (169.6 [169–199] € vs. 642.5 [561–775] €; p < 0.001). At follow‐up, pain and sperm variables significantly improved in both groups (p < 0.01), without differences among the embolic materials. Linear regression model revealed that coils use was associated with higher radiation exposure (beta 8.8, p = 0.02) than SA after accounting for anatomic variation of gonadal vein, body mass index, and vascular access. Conclusions SA and coils for varicocoele embolization are equally safe and effective. The use of SA was associated with lower radiation exposure and procedural costs than coils. These results should be considered in terms of public health cost and patient's safety.
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Affiliation(s)
- Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Irene Fulgheri
- Department of Vascular Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cristina
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierpaolo Biondetti
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Rossi
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Grimaldi
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpaolo Lucignani
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele University Vita-Salute San Raffaele, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Università degli Studi di Milano, Milan, Italy.,Infertility Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
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AHMED MI, ATTALA KA. Transcatheter foam sclerotherapy in the management of male varicocele: a single-center experience. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Relevant Biological Effects of Varicocele Embolization with N-Butyl Cyanoacrylate Glue on Semen Parameters in Infertile Men. Biomedicines 2021; 9:biomedicines9101423. [PMID: 34680539 PMCID: PMC8533197 DOI: 10.3390/biomedicines9101423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Surgical treatment or varicocele embolization (VE) with sclerosing or mechanical embolic agents have been shown to improve the semen parameters of infertile men. The aim of this study was to evaluate the impact of VE using N-butyl cyanoacrylate (NBCA) glue on semen parameters in infertile men. From January 2014 to June 2018, infertile adult patients with stage 3 varicocele and an initial semen analysis showing at least one abnormal semen parameter, and who were successfully embolized with NBCA Glubran®2 glue, were retrospectively recruited. The availability of a second semen analysis after VE was mandatory for patient inclusion. The primary endpoint was the change in total sperm number (TSN) after VE. The other parameters of interest were progressive and total sperm motilities (Smot) at 1 h (H1), sperm vitality (SV) and morphology (SMor). One hundred and two patients were included. Eight patients presented null TSN before and after VE. Among the remaining 94 patients, a significant improvement in the median TSN after VE was shown (31.79 × 106/ejaculate [IQR: 11.10-127.40 × 106/ejaculate] versus 62.24 × 106/ejaculate [IQR: 17.90-201.60 × 106/ejaculate], p = 0.0295). Significant improvement in TSN was found for the 60 oligo- or azoospermic patients (p = 0.0007), whereas no significant change was found for the 42 patients with normal initial TSN (p = 0.49). Other parameters, such as progressive and total SMot, SV and SMor, also significantly improved after VE (p = 0.0003, 0.0013, 0.0356 and 0.007, respectively). The use of NBCA glue as an embolic agent for VE in infertile men with stage 3 varicocele significantly improves the semen parameters.
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8
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Wadhwa V, Kashanian JA, Schiffman M, McClure TD. Varicocele Embolization: Patient Selection: Preprocedure Workup, and Technical Considerations. Semin Intervent Radiol 2021; 38:176-181. [PMID: 34108803 DOI: 10.1055/s-0041-1727105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Varicocele refers to an abnormally dilated and tortuous pampiniform venous plexus within the spermatic cord. The prevalence of varicocele is reported to be approximately 15% in the general male population. Its incidence increases with age and has a higher incidence in infertile men. Varicocele treatment (surgical or interventional) is considered one of the most common therapies of reversible infertility in men. Percutaneous embolization offers nonsurgical, minimally invasive option for the treatment of varicoceles, requiring only minimal sedation. In this article, the authors review the clinical and technical details of percutaneous varicocele embolization with a summary of currently available evidence.
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Affiliation(s)
- Vibhor Wadhwa
- Departments of Urology and Radiology, Weill Cornell Medicine, New York City, New York
| | - James A Kashanian
- Departments of Urology and Radiology, Weill Cornell Medicine, New York City, New York
| | - Marc Schiffman
- Departments of Urology and Radiology, Weill Cornell Medicine, New York City, New York
| | - Timothy D McClure
- Departments of Urology and Radiology, Weill Cornell Medicine, New York City, New York
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Sheehan M, Briody H, O'Neill DC, Bowden D, Davis NF, Given M, Mohan P, Lee MJ. Pain relief after varicocele embolization: The patient's perspective. J Med Imaging Radiat Oncol 2020; 64:215-219. [PMID: 32048477 DOI: 10.1111/1754-9485.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Long-term efficacy of treatment with varicocele embolization is poorly documented from the patient's perspective. This study assessed patients' perceived changes in pain scores pre- and post-testicular vein embolization. In addition, the effect of testicular vein embolization on quality of life (QoL) parameters was assessed. METHODS All patients treated with embolization for varicocele-related orchalgia were analysed (2009-2015). A standardized pain impact questionnaire was used to assess pain scores pre- and post-procedure. The primary outcome was to assess patients' pain relief post-varicocele embolization. The secondary outcome was patients' perceived efficacy of the embolization procedure in terms of improvement in QoL parameters. RESULTS Sixty patients underwent varicocele embolization due to persistent orchalgia; of which 44 responded to the questionnaire. The mean pre-procedural pain score was 5.4/10 (range of 1.5-9). Post-procedure questionnaire was performed at a median of 58 months (range 28-106 months). At 1, 6 and 12 months post-procedure, the mean pain score was 1.57, 0.55 and 0.3, respectively. 50% (n = 22) reported complete pain relief 1-month post-embolization while 89% (n = 39) of patients reported complete resolution of pain at 1 year. Among the measured QoL parameters; varicocele embolization resulted in significant improvement in return to work, housework, socializing, exercise, sexual relations, and sleeping post-embolization (P < 0.01). CONCLUSION Varicocele embolization results in a durable reduction in pain scores compared to their pre-operative values. Information from this study will allow clinicians to convey the potential improvements in pain parameters to patients undergoing embolization of symptomatic varicoceles.
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Affiliation(s)
- Mark Sheehan
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Hayley Briody
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | | | - Dermot Bowden
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons (RCSI), Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Ponnusamy Mohan
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons (RCSI), Dublin, Ireland
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10
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Çayan S, Orhan İ, Akbay E, Kadıoğlu A. Systematic review of treatment methods for recurrent varicoceles to compare post‐treatment sperm parameters, pregnancy and complication rates. Andrologia 2019; 51:e13419. [DOI: 10.1111/and.13419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Selahittin Çayan
- Department of Urology University of Mersin School of Medicine Mersin Turkey
| | - İrfan Orhan
- Department of Urology Fırat University School of Medicine Elazığ Turkey
| | - Erdem Akbay
- Department of Urology University of Mersin School of Medicine Mersin Turkey
| | - Ateş Kadıoğlu
- Department of Urology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
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11
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Perdikakis E, Tzortzis V, Fezoulidis I, Rountas C. Intravascular Ultrasound for Evaluation of Left Gonadal Vein Anatomic Variations During Coil Embolization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1619-1627. [PMID: 30244482 DOI: 10.1002/jum.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
We illustrate the intravascular ultrasound (US) findings in the evaluation of left gonadal vein anatomic variations. During a 2-year period, 4 consecutive patients (mean age, 37 years; range, 28-45 years) with left-sided varicocele underwent embolization. Intravascular US examinations and retrograde venography were performed to assess varicocele anatomy. Anatomic variants were recorded and categorized. A comparison between intravascular US and fluoroscopic findings was performed. The Fisher exact test was used for statistical analysis (P < .05). Technical success was achieved in all cases. There was a statistically significant difference in the maximum gonadal vein diameter between venography and intravascular US (P = .0087). Intravascular US showed left gonadal vein anatomic variations and better ability in the evaluation of the vein diameter.
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Affiliation(s)
- Evangelos Perdikakis
- Department of Radiology, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
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12
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Mongioì LM, Mammino L, Compagnone M, Condorelli RA, Basile A, Alamo A, La Vignera S, Morgia G, Russo GI, Calogero AE. Effects of Varicocele Treatment on Sperm Conventional Parameters: Surgical Varicocelectomy Versus Sclerotherapy. Cardiovasc Intervent Radiol 2018; 42:396-404. [PMID: 30519724 DOI: 10.1007/s00270-018-2136-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Varicocele is often associated with impaired sperm parameters. Different procedures have been developed for varicocele treatment. The aim of this study was to evaluate the effects of varicocele treatment on conventional sperm parameters. MATERIALS AND METHODS We compared two different techniques of intervention: surgical varicocelectomy and sclerotherapy. We also evaluated the number of varicocele recurrences and the pregnancy rate. We included 102 patients (mean age 29.8 ± 0.8 years) with ultrasound diagnosis of varicocele. We excluded patients whose ultrasound evaluation and/or sperm parameters were not known before and after varicocele correction. We divided the patients (excluding 8 with azoospermia) into two subgroups: surgical varicocelectomy (n = 44) and sclerotherapy (n = 50). For each patient, we compared conventional sperm parameters before and after varicocele correction. RESULTS After varicocele correction, we found a significant improvement in sperm concentration, total count and total motility. Considering the two subgroups, baseline sperm parameters did not differ significantly. Sperm concentration and total count increased significantly after varicocele correction by varicocelectomy. Varicocele correction by sclerotherapy resulted in a significant increase in sperm concentration, progressive and total motility. We found varicocele recurrence in 32% of patients who underwent varicocelectomy and in 19.7% of patients undergoing sclerotherapy. The pregnancy rate was higher after sclerotherapy (28%) than after surgical varicocelectomy (13%). CONCLUSION Varicocele treatment must be recommended when other causes of infertility have been treated. Our results suggest the use of sclerotherapy for varicocele repair. LEVEL OF EVIDENCE 2 b.
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Affiliation(s)
- Laura Maria Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Luca Mammino
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Michele Compagnone
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Rosita Angela Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Angela Alamo
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Giuseppe Morgia
- Department of Surgery, Urology Section, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Aldo Eugenio Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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13
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Perdikakis E, Fezoulidis I, Tzortzis V, Rountas C. Varicocele embolization: Anatomical variations of the left internal spermatic vein and endovascular treatment with different types of coils. Diagn Interv Imaging 2018; 99:599-607. [PMID: 29910172 DOI: 10.1016/j.diii.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To present anatomical variations of left internal spermatic vein and a comparison between treatments with hydrogel-coated and non-coated platinum coils in patients with varicocele. MATERIALS AND METHODS A total of 153 men (mean age, 27.5±6.7 [SD] years; range: 18-45 years) with left sided varicocele underwent coil embolization. Anatomic variants of gonadal vein were categorized into five subtypes (I-V). Additional venous collaterals were also recorded. Three types of coils were used (hydrogel coated platinum coils, fibered coils and non-coated platinum coils). Technical success, tolerance, efficacy and safety of hydrogel coated platinum coils were recorded. Comparison between different types of coils used was made. Fisher's exact test was used for statistical analysis. RESULTS Varicoceles were classified as type I (26.1%), type II (13.7%), type III (32.1%), type IV (18.3%) and type V (9.8%). The internal spermatic vein - renal vein angle ranged from 32°-128° (mean angle, 93.5°). Technical success was achieved in 145 patients (94.8%) without complications. The mean number of coils used was 3 (range: 1-6 coils). A total of 260 hydrogel coated platinum coils in 95 patients and 135 non-coated coils in 50 patients were deployed with no complications. No differences were noted between the different types of coils used regarding embolic efficacy and safety. A 6.2% (9/145) recurrence rate and a 33.3% (14/42) fertility rate were observed. Clinical success regarding symptom relief after painful varicocele embolization was 100% (36/36) for technically successful cases. CONCLUSION Varicocele embolization with the use of hydrogel coated or non-coated platinum coils is technically feasible and safe without complications. No superiority of one type of coil over the other was found.
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Affiliation(s)
- E Perdikakis
- Department of Radiology, 424 GMTH Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - I Fezoulidis
- Department of Radiology, University of Thessaly, Larisa, Greece
| | - V Tzortzis
- Department of Urology, University of Thessaly, Larisa, Greece
| | - C Rountas
- Department of Radiology, University of Thessaly, Larisa, Greece
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Sack BS, Schäfer M, Kurtz MP. The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired? Curr Urol Rep 2017; 18:38. [PMID: 28315171 DOI: 10.1007/s11934-017-0686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long-term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.
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Affiliation(s)
- Bryan S Sack
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mattias Schäfer
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Muehlgasse 19, 90419, Nuremberg, Germany
| | - Michael P Kurtz
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
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Tsili AC, Xiropotamou ON, Sylakos A, Maliakas V, Sofikitis N, Argyropoulou MI. Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele. World J Radiol 2017; 9:34-45. [PMID: 28298963 PMCID: PMC5334500 DOI: 10.4329/wjr.v9.i2.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/02/2016] [Accepted: 12/19/2016] [Indexed: 02/07/2023] Open
Abstract
Varicocele is characterized by an abnormal dilatation and retrograde blood flow in the spermatic veins. Varicocele is the leading correctable cause of male infertility. Although it is highly prevalent in infertile men, it is also observed in individuals with normal fertility. Determining which men are negatively affected by varicocele would enable clinicians to better select those men who will benefit from treatment. To assess the functional status of the testes in men with varicocele, color Doppler sonographic parameters were evaluated. Testicular arterial blood flow was significantly reduced in men with varicocele, reflecting an impairment of spermatogenesis. An improvement in the testicular blood supply was found after varicocelectomy on spectral Doppler analysis. Testicular contrast harmonic imaging and elastography might improve our knowledge about the influence of varicocele on intratesticular microcirculation and tissue stiffness, respectively, providing possible information on the early damage of testicular structure by varicocele. Magnetic resonance imaging (MRI), with measurement of apparent diffusion coefficient has been used to assess the degree of testicular dysfunction and to evaluate the effectiveness of varicocele repair. Large prospective studies are needed to validate the possible role of functional sonography and MRI in the assessment of early defects of spermatogenesis in testes with varicocele.
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Abstract
Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords “recurrent” and “varicocele” as well as MESH criteria “recurrent” and “varicocele.” Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.
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Affiliation(s)
| | - Mark Sigman
- Department of Surgery, division of Urology, Brown University, 2 Dudley Street, Suite #174, Providence, RI 02905, USA
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Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl 2016; 18:234-8. [PMID: 26658060 PMCID: PMC4770492 DOI: 10.4103/1008-682x.169985] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.
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Affiliation(s)
| | | | | | | | - Ranjith Ramasamy
- Department of Urology, University of Miami - Miller School of Medicine, Miami 33136, USA
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Talaie R, Young SJ, Shrestha P, Flanagan SM, Rosenberg MS, Golzarian J. Image-Guided Treatment of Varicoceles: A Brief Literature Review and Technical Note. Semin Intervent Radiol 2016; 33:240-3. [PMID: 27582613 DOI: 10.1055/s-0036-1586140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Shamar J Young
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Prashant Shrestha
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Siobhan M Flanagan
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Michael S Rosenberg
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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Chiba K, Fujisawa M. Clinical Outcomes of Varicocele Repair in Infertile Men: A Review. World J Mens Health 2016; 34:101-9. [PMID: 27574593 PMCID: PMC4999483 DOI: 10.5534/wjmh.2016.34.2.101] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022] Open
Abstract
Varicoceles are a major cause of impaired spermatogenesis and the most common correctable cause of male infertility. They are found in approximately 40% of men with primary infertility and 80% of men with secondary infertility, although they also occur in 12% of men with normal semen parameters. The presence of a varicocele does not always affect spermatogenesis, as it has been reported that only 20% of men with documented varicoceles suffer fertility problems. However, varicocele repair appears to have beneficial effects in men with impaired semen parameters and palpable varicoceles. Currently, the main procedures employed for varicocele repair are microsurgical subinguinal or inguinal varicocelectomy, laparoscopic varicocelectomy, and radiological percutaneous embolization. Microsurgical varicocelectomy appears to be the optimal treatment in most cases, whereas the other procedures are useful only in specific cases. After treatment, it typically takes 3 to 6 months for patients' semen parameters to improve; thus, other therapies, including assisted reproductive technology, should be considered if infertility persists after this interval, especially in older couples. Controversies still remain regarding how varicoceles in certain subgroups, such as adolescents or men with azoospermia, should be treated. Due to their relatively high prevalence rate among the general population, varicoceles can occur concomitantly with other conditions that cause impaired spermatogenesis. Further studies are necessary in order to identify the patients who are most likely to benefit from treatment. In this review, we sought to summarize the issues currently associated with varicocele treatment in infertile men.
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Affiliation(s)
- Koji Chiba
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Favard N, Moulin M, Fauque P, Bertaut A, Favelier S, Estivalet L, Michel F, Cormier L, Sagot P, Loffroy R. Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate. Quant Imaging Med Surg 2016; 5:806-14. [PMID: 26807362 DOI: 10.3978/j.issn.2223-4292.2015.10.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To evaluate pain, radiation and recurrence rates in patients undergoing varicocele embolization with three different embolic materials. METHODS Retrospective study of 182 consecutive patients who underwent transcatheter retrograde varicocele embolization from July 2011 to May 2015 with glue (Glubran(®)2) (group 1, n=63), mechanical agents (coils and/or plugs) (group 2, n=53) or a sclerosing agent (polidocanol) (group 3, n=66). Patients were asked by telephone interview to evaluate pain during embolization and at 1, 7 and 30 days using a quantitative pain scale ranging from 0 to 10. Duration of scopy, kinetic energy released per unit mass (kerma) and dose area product (DAP) were assessed as radiation parameters during embolization procedures. Recurrence rates after treatment were also evaluated. Statistical analyses were performed using parametric and non-parametric tests. RESULTS Patients in the three study groups were comparable for age, clinical indication and embolization side. No difference was noted for significant pain (pain score ≥3) during embolization and at 1, 7 and 30 days after treatment. Discomfort (pain score <3) was more frequent in group 1 than in groups 2 and 3 at 7 days after the procedure (P=0.049). No difference in discomfort was noted during embolization or at 1 and 30 days. Duration of scopy was shorter (P<0.0001) and kerma was lower (P=0.0087) in group 1 than in groups 2 and 3. DAP was lower in group 1 than in group 2 (P=0.04) but no difference was noted between groups 1 and 3, and groups 2 and 3. The recurrence rate at a mean follow-up of 24.4 months (range, 2-53 months) was significantly lower in group 1 than in the two other groups (P=0.032). CONCLUSIONS The use of Glubran(®)2 acrylic glue for varicocele embolization is safe and leads to less radiation and lower recurrence rates than is the case for other embolic materials without any more significant pain.
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Affiliation(s)
- Nicolas Favard
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Morgan Moulin
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Patricia Fauque
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Aurélie Bertaut
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Sylvain Favelier
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Louis Estivalet
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Frédéric Michel
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Luc Cormier
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Paul Sagot
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| | - Romaric Loffroy
- 1 Deparment of Vascular, Oncologic and Interventional Radiology, 2 Department of Urology and Andrology, 3 Laboratory of Biology of Reproduction, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 4 Department of Biostatistics, Georges François Leclerc Center, Dijon, France ; 5 Department of Gynaecology-Obstetrics, Fœtal Medicine and Sterility of Couple, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon Cedex, France ; 6 LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
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Ali A, Wirth S, Treitl KM, Treitl M. Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients' satisfaction with regard to alternative techniques. Eur Radiol 2015; 25:2889-97. [PMID: 25796582 DOI: 10.1007/s00330-015-3684-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 02/10/2015] [Accepted: 02/18/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We report our experience with polidocanol foam sclerotherapy with no additional coils, evaluating clinical success, patients' satisfaction, and complications. METHODS We conducted a retrospective study of 141 patients with 146 varicoceles (mean age: 29.3 years; range: 13 - 60 years) who underwent foam sclerotherapy with polidocanol 2% (range: 2 - 12 ml) in an outpatient setting between January 2007 and December 2013. For the follow-up, telephone interviews with the patients were conducted (mean follow-up time: 46.4 months, standard deviation: 20.17 months). RESULTS The technical success rate was 91.8%. There was a 55.8% response rate to the telephone interviews. Follow-up revealed a clinical success rate of 83.9% and a persistence or relapse rate of 16.1%. Of the patients, 81.9% were absolutely satisfied with the outcome. In 94.9% of cases, pain or discomfort resolution was reported, and in 97% of cases, aesthetic issues were no longer a problem. Of partners, 63.2% achieved pregnancy, and in 50% of patients with preprocedural testicular atrophy, catch-up growth was observed. One patient with pampiniform plexus phlebitis received inpatient treatment with no long-term damage recorded. CONCLUSIONS Polidocanol foam varicocele sclerotherapy is a safe and effective procedure, with a high rate of patients' satisfaction, clinical and technical success, and considerable catch-up growth and pregnancy achievement. KEY POINTS • Varicocele treatment using polidocanol foam sclerotherapy is a safe and effective procedure. • It is easily feasible in an outpatient setting. • The clinical and technical success rates are high. • It shows a high rate of patients' satisfaction and symptom resolution. • Postinterventional catch-up growth and pregnancy achievement are considerable.
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Affiliation(s)
- Alma Ali
- Institute for Clinical Radiology, Hospital of the Ludwig-Maximilians University of Munich, Nussbaumstr. 20, 80336, Munich, Germany,
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