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Published on: December 22, 2023
Varicocele percutaneous embolization outcomes in a pediatric group: 7-year retrospective study
Sonaz Malekzadeh1,2, Rodrigo A Fraga-Silva3, Pierre-Henri Morère4
1Department of Radiology, Sion Hospital, Sion, Switzerland. soonazmalakzadeh@gmail.com.
Insights
Percutaneous embolization for pediatric varicocele demonstrates high technical success (93%) and low recurrence (13%), with fewer complications than surgery. This study supports embolization as a superior treatment option for children with varicocele.
Area of Science:
- Pediatric Urology
- Interventional Radiology
- Vascular Surgery
Background:
- Varicocele treatment options include percutaneous embolization and surgical repair, with ongoing debate regarding their comparative efficacy.
- Evaluating treatment outcomes in pediatric populations is crucial for establishing best practices.
Purpose of the Study:
- To compare the technical success, complication, and recurrence rates of percutaneous varicocele embolization in pediatric patients.
- To assess the safety and effectiveness of embolization as a treatment for pediatric varicocele.
- To compare embolization outcomes with reported surgical repair data.
Main Methods:
- A retrospective study of 30 children undergoing percutaneous varicocele embolization.
- Evaluation of varicocele characteristics, symptoms, testicular asymmetry, recurrence, radiation dose, and complications.
- Review of recurrence and follow-up complications post-embolization.
Main Results:
- Technical success rate of 93% (28/30 patients).
- Low complication rate, with only one patient experiencing venous injury.
- Recurrence rate of 13% (4/30 patients), with a mean radiation dose significantly lower than abdominal CT scans.
Conclusions:
- Percutaneous embolization offers a comparable success and recurrence rate to surgical methods for pediatric varicocele.
- Embolization presents a lower complication profile due to its intravascular approach, minimizing risks to testicular arteries and spermatic cords.
- The findings support percutaneous embolization as a superior treatment modality for pediatric varicocele compared to surgical interventions.
Purpose:
Percutaneous embolization and surgical repair are the current treatment options for varicocele, but determining method superiority remains controversial. In this retrospective study, we evaluate the technical success, complication and recurrence rates following percutaneous embolization in a pediatric group, which were compared to reported outcomes for surgical repairs.
Methods:
Thirty children treated for percutaneous varicocele embolization were recruited. The side and grade of varicocele, symptoms, testicular asymmetry, mean recurrence time, total radiation dose and complications were evaluated. Recurrence and follow-up complications due to embolization were also reviewed.
Results:
The venography showed retrograde filling of the internal spermatic vein with the identification of aberrantly fed vessels in 23 % of patients. None of the patients suffered from procedure complications except one who had venous injury which was treated with a sclerosing agent. The technical success rate was 93 % (28 patients) with a recurrence rate of 13 % (4 patients). Interestingly, the mean radiation dose used was 862.5 µGy m(2), 3 times lower than abdominal CT.
Conclusion:
Considering the intravascular nature of embolization, which aims to avoid testicular artery and spermatic cord damage (difficult to avoid with the surgical method), and consequently a lower complication rate, along with the same success rate and recurrence rate, our study supports that embolization is a superior method to surgical interventions.
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