Retrograde embolization of varicocele: our experience

Giuseppe Salinitri1, Giuseppe Fragapane1, Angelo Spinazzola2, Pasqualino Alongi1, Silvio De Cenzo1, Nicola Cionfoli2, Alessandro Baresi1
  • 1 Ospedale Maggiore, U.O. Urologia (Crema)
  • 2 Ospedale Maggiore, U.O. Radiologia (Crema)

Objective

As part of minimally invasive surgery of varicocele we wanted to evaluate the efficacy and morbidity of scleroembolizzazione retrograde.

Materials and Methods

From June 2009 to January 2014 were recruited 120 patients, aged 15 years and 40 years (median age 27.5 years) with various degrees of varicocele found all'ecocolordoppler scrotal and associated alteration, the semen analysis pre-operative, the fertility parameters (oligo-astheno-teratozoospermia) and underwent surgery mini invasive retrograde selective embolization of the left spermatic vein. 100/120 of these patients were subjected to selective embolization dellla spermatic vein with sclerosing solution and 20 patients with use of spirals. All patients were evaluated with Doppler ultrasound examination scrotal at 7 days to 1, 3, 6, 12 and 24 months and a semen analysis at 6 and 12 months.

Results

106/120 patients (88.3%) had no complications. 5 of 120 patients (4.1%) did not undergo the procedure for issues related to anatomy not complacent, 4/120 (3.3%) had a recurrence at 3 months and therefore started to traditional surgery, 2 patients (1.6%) developed un'orchiepididimite reactive substance sclerosing in the post-intervention. Of the 20 patients treated with spirals 10 (50%) had not benefited from the treatment controls 7 and 30 days. At a median follow-up of 12 months there has been a marked improvement in the parameters of fertility after semen analysis on 72% of patients treated with a fertility index of 30%.

Discussions

The varicocele may arise already in pre-adolescent age (reflected in the 2-
2.5% of children between 7 and 10 years) but the era in which it normally occurs
that of sexual maturation, between 11 and 16 years. The finding of
varicocele in this age group is different depending on the studies carried out
(varies from an incidence of 13 to 28%) but is still similar to that
adulthood.
The retrograde embolitazion is a minimally invasive technique used in the treatment of varicocele.
The advantages over traditional surgery are:
More effective in terms of pain reduction in post operative
Hospitalization times short
Lower rate of complications and recurrence compared to traditional surgery (4-5% vs. 25-30%).

Conclusion

The selective embolization of the spermatic vein is performed on an outpatient basis and in regional anesthesia. From our experience has shown that and is still reliable, effective and minimally invasive and with a very low complication rate. The length of stay is very short and the patient usually resumes its normal course of business the day after the procedure.
At a median follow-up of 12 months, we have seen a significant improvement in fertility rates and a significantly lower relapse rate compared to traditional surgical techniques.
The use of sclerosing substances appears to be, at least in our clinical experience, much more effective than the use of endovascular coils.

References

Beneficial Effect of Microsurgical Varicocelectomy
is Superior for Men With Bilateral Versus Unilateral Repair
Jamie Libman,* Keith Jarvi, Kirk Lo and Armand Zini†
Vol. 176, 2602-2605, December 2006
THE JOURNAL OF UROLOGY

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