Rationale for antegrade sclerotherapy in varicoceles

Clipping of the testicular veins in varicocele in principle follows open surgical treatment modalities such as the Palomo and Bernardi operations by disrupting venous reflux of the testicular veins. Thus, success rates of laparoscopic varicocelectomy range around 85% as well. As a less invasive means of treatment, retrograde (interventional) sclerotherapy of varicocele has produced long-term results as favorable as those of open surgical procedures. Antegrade sclerotherapy was introduced by Tauber as an equivalent, but even less invasive treatment modality, done by the urologist. We have performed antegrade sclerotherapy in more than 80 patients with left-sided primary varicocele. The procedure was done in local anesthesia via a scrotal incision and lasted between 12 and 60 min. If different treatment modalities yield similar long-term results, they must be valued according to how these outcomes are achieved. With antegrade sclerotherapy, the urologist has a modality at hand that is not only less invasive than laparoscopic varicocelectomy, but bears fewer risks for the patient, requires less personnel and costs less. Therefore, we consider laparoscopic varicocelectomy indicated only if antegrade sclerotherapy cannot be performed or has been tried twice without success. However, it may still be considered in bilateral varicoceles.