Anterograde spermatic vein sclerotherapy: Step-by-step Tauber procedure

Varicocele is a common condition characterised by the abnormal dilation of pampiniform plexus veins due to venous reflux and it becomes more frequent with puberty. Since varicocele treatment has been correlated with testicular catch-up growth and improved sperm parameters, a variety of surgical techniques have been developed.

The patient is positioned in the supine position. A 2 cm incision at the scrotal root level is performed. After dissection, the pampiniform plexus veins are identified and the most dilated and straight is isolated and prepared for cannulation. A 20-24 G, 7 cm long, hollow, flexible and transparent cannula is employed with the oblique-cut ending inserted in the selected vein. After assessing the vein patency, the fluoroscopic C-arm is positioned and a contrast agent is injected for visualization of the spermatic vein up until its convergence with the renal vein. The sclerosing agent (Aethoxysklerol/Fibrovein) is mixed with air to make a foam and immediately injected into the spermatic vein under fluoroscopic vision. This allows modulation of the amount of sclerosing agent which is injected until the complete disappearance of the contrast medium is clearly seen on the monitor. The cannula is then removed avoiding any spillage by a normal saline flush. The vein is ligated cranially and caudally and tissues closed with absorbable sutures.

Antegrade sclerotherapy is safe and effective for the treatment of paediatric varicocele. Radiation doses during the procedure are minimal.

Tauber's technique could be considered an appropriate option for the treatment of varicocele in the paediatric population.