Phlebography: why it is important to study radiological imaging of spermatic veins

We delineate the role of phlebography which is a standard procedure during antegrade and retrograde sclerotherapy of idiopathic varicoceles.

Based on our experience with antegrade sclerotherapy in 5,254 adults and adolescents we present typical phlebographies of the internal spermatic vein and radiological images after irregular cannulation of different arteries and veins on the scrotal floor. The sequalae of misinjections and paravascular application of the sclerosing agent polidocanol are discussed. A radiological classification of venous drainage roots of the pampiniform plexus is introduced on the basis of 236 consecutive antegrade phlebographies. The findings are compared with the results of retrograde phlebography previously given in literature.

Phlebography helps to ascertain that sclerotherapy is performed in an anatomically appropriate manner. Thus, misinjections and paravascular applications of polidocanol can be ruled out. Antegrade phlebography enables to visualize a high rate of side veins and collaterals of the internal spermatic vein and thus seems to be equivalent to the retrograde imaging in tracing the additional drainage roots of the pampiniform plexus. These additional roots are considered to be the source of persisting varicoceles after surgical treatment.

Phlebography is needed to achieve good results after sclerotherapy of varicoceles and to minimize the toxic side effects of polidocanol. Finally it is a prove that the treatment has been performed accurately for forensic reasons.