[Spermatic phlebography and sclerotherapy of the male varicocele]

Phlebographic sclerotherapy and embolization are better methods, from the biological and cost-effectiveness viewpoints, to treat male varicocele than conventional surgery. On the other hand, positive technical results are not always obtained and the rates of relapses and recurrences are high. A retrospective study was carried out on 70 (of 81) sclerotherapies performed in the Radiology Department of S. Anna Hospital, Turin, from 1993 to September, 1995. The results confirmed the feasibility of this treatment in a nonangiographic department, with technical success rates increasing with growing operators' experience (70% success rate in 1993, vs. more than 95% in 1994-95). Recurrence rate was 4.9% and the rate of limited persistence was 7.3% at clinical and Doppler follow-up ranging 6-24 months (mean: 10.2 months). Both rates appeared to be related to varicocele initial size, increasing progressively from grade I to grade III. Therefore, such new and expensive techniques as balloon or spiral embolization are justified only in the most severe cases. The follow-up showed improved or normalized sperm exams in 70.4% of treated and followed-up patients, with 5 full-term pregnancies. To conclude, sclerotherapy and embolization of the spermatic vein are very good tools to treat male varicocele with subfertility.