Post-surgical recurrent varicocele: efficacy of internal spermatic venography and steel-coil embolization

To delineate the venographic anatomy of the varicoceles which recur following conventional inguinal varicocele ligation and to determine the therapeutic efficacy of steel-coil embolization as assessed by improvements in seminal parameters and paternity.

Thirty-nine patients with post-surgical recurrent varicoceles underwent bilateral internal spermatic venography approached through the right femoral vein. The collateral venous channels were identified and occluded using appropriate sizes of steel coils.

The procedure was technically successful in 33 patients (85%). Analysis of the 33 venograms showed a unilateral left-sided recurrent varicocele in 28 patients (85%) and bilateral recurrent varicoceles in five patients (15%). The mid and lower parallel collateral channels were observed in 27 patients (82%). The recurrences were treated easily with stainless steel-coil embolization. Five patients were lost to follow-up. Of the remaining 28 patients the sperm count and motility became normal in 16 (57%); only the motility improved in three patients (10%) while in nine patients (33%) there were no changes in either of the seminal parameters. Five patients achieved paternity.

Internal spermatic venography allowed a precise anatomical definition of the recurrent varicocele and the use of steel-coil embolization provided satisfactory improvements in sperm quality and paternity.