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[Percutaneous sclerotherapy of testicular vein insufficiency in persistent and recurrent varicocele]
Insights
Sclerotherapy is an effective treatment for persistent or recurrent varicocele after surgery or prior sclerotherapy. This low-risk outpatient procedure offers a viable option for managing varicocele recurrence.
Area of Science:
- Urology
- Vascular Surgery
Background:
- Varicocele, a common cause of male infertility, can persist or recur after initial treatment.
- Idiopathic varicoceles affect the left testicular vein, necessitating effective management strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of sclerotherapy for persistent or recurrent varicoceles.
- To compare outcomes of sclerotherapy after surgical ligation versus previous sclerotherapy.
Main Methods:
- Retrospective analysis of 1217 retrograde phlebographies in patients with left-sided idiopathic varicoceles.
- Assessment of 66 patients with persistent or recurrent varicoceles, including 34 post-operation and 32 post-sclerotherapy.
Main Results:
- Post-operative recurrence was often linked to reflux at the ligation site.
- Post-sclerotherapy recurrence typically involved obliteration of the testicular vein with reflux via collaterals.
- Repeat sclerotherapy was feasible in 12 of 32 patients with persistent main stems after initial sclerotherapy.
Conclusions:
- Sclerotherapy is an effective, low-risk outpatient treatment for varicocele recurrence.
- It offers a viable alternative for patients who have undergone prior surgery or sclerotherapy.
- Careful patient selection and imaging are crucial for successful repeat sclerotherapy.
Abstract:
Among 1217 retrograde phlebographies of left-sided idiopathic varicoceles 66 patients presented because of persistence or recurrence of varicocele, 34 of them after operation and 32 after sclerotherapy. After operation without success there was always - except for one case - a reflux passing the site of ligature. If persistence or recurrence of varicocele occurred after sclerotherapy, the testicular (internal spermatic) vein was most often found to be obliterated at the junction with the renal vein and the sonographically proven reflux went via collaterals or unidentified veins which prevented a repeat sclerotherapy. In 12 out of 32 patients after sclerotherapy a persistent main stem of the testicular vein allowed a second attempt of sclerotherapy. If sclerotherapy in patients after operation or previous sclerotherapy could be performed, it was an effective, low risk procedure on an outpatient basis just as in primary sclerotherapy of testicular vein insufficiency causing varicocele.