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Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients’ satisfaction with regard to alternative techniques

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We report our experience with polidocanol foam sclerotherapy with no additional coils, evaluating clinical success, patients’ satisfaction, and complications.

Methods

We conducted a retrospective study of 141 patients with 146 varicoceles (mean age: 29.3 years; range: 13 – 60 years) who underwent foam sclerotherapy with polidocanol 2 % (range: 2 – 12 ml) in an outpatient setting between January 2007 and December 2013. For the follow-up, telephone interviews with the patients were conducted (mean follow-up time: 46.4 months, standard deviation: 20.17 months).

Results

The technical success rate was 91.8 %. There was a 55.8 % response rate to the telephone interviews. Follow-up revealed a clinical success rate of 83.9 % and a persistence or relapse rate of 16.1 %. Of the patients, 81.9 % were absolutely satisfied with the outcome. In 94.9 % of cases, pain or discomfort resolution was reported, and in 97 % of cases, aesthetic issues were no longer a problem. Of partners, 63.2 % achieved pregnancy, and in 50 % of patients with preprocedural testicular atrophy, catch-up growth was observed. One patient with pampiniform plexus phlebitis received inpatient treatment with no long-term damage recorded.

Conclusions

Polidocanol foam varicocele sclerotherapy is a safe and effective procedure, with a high rate of patients’ satisfaction, clinical and technical success, and considerable catch-up growth and pregnancy achievement.

Key Points

• Varicocele treatment using polidocanol foam sclerotherapy is a safe and effective procedure.

• It is easily feasible in an outpatient setting.

• The clinical and technical success rates are high.

• It shows a high rate of patients’ satisfaction and symptom resolution.

• Postinterventional catch-up growth and pregnancy achievement are considerable.

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Abbreviations

DNA:

Deoxyribonucleic acid

Fr:

French

NBCA:

N-butyl-cyano-acrylate

NBCA-MS:

N-butyl-cyano-acrylate + methacryloxysulfolane

STS:

sodium tetradecyl sulfate

References

  1. Bittles MA, Hoffer EK (2008) Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome. Semin Intervent Radiol 25(3):261–270

    Article  PubMed Central  PubMed  Google Scholar 

  2. Lehtihet M, Arver S, Kalin B, Kvist U, Pousette A (2014) Left-sided grade 3 varicocele may affect the biological function of the epididymis. Scand J Urol 48(3):284–289

    Article  PubMed  Google Scholar 

  3. Puche-Sanz I, Flores-Martín JF, Vázquez-Alonso F, Pardo-Moreno PL, Cozar-Olmo JM (2014) Primary treatment of painful varicocele through percutaneous retrograde embolization with fibred coils. Andrology 2(5):716–720

    Article  CAS  PubMed  Google Scholar 

  4. Nabi G, Asterlings S, Greene DR, Marsh RL (2004) Percutaneous embolization of varicoceles: outcomes and correlation of semen Improvement with pregnancy. Urology 63(2):359–363

    Article  CAS  PubMed  Google Scholar 

  5. Zuckerman AM, Mitchell SE, Venbrux AC et al (1994) Percutaneous varicocele occlusion: long-term follow-up. J Vasc Interv Radiol 5(2):315–319

    Article  CAS  PubMed  Google Scholar 

  6. Vanlangenhove P, Everaert K, Van Maele G, Defreyne L (2014) Tolerance of glue embolization under local anesthesia in varicoceles: a comparative study of two different cyanoacrylates. Eur J Radiol 83(3):559–563

    Article  PubMed  Google Scholar 

  7. Urbano J, Cabrera M, Alonso-Burgos A (2014) Sclerosis and varicocele embolization with N-butyl-cyanoacrylate: experience in 41 patients. Acta Radiol 55(2):179–185

    Article  PubMed  Google Scholar 

  8. Sze DY, Kao JS, Frisoli JK (2008) Persistent and recurrent postsurgical varicoceles: venographic anatomy and treatment with NBCA embolization. J Vasc Interv Radiol 19(4):539–545

    Article  PubMed  Google Scholar 

  9. Heye S, Maleux G, Wilms G (2006) Pain experience during internal spermatic vein embolization for varicocele: comparison of 2 cyanoacrylate glues. Eur Radiol 16(1):132–136

    Article  PubMed  Google Scholar 

  10. Hawkins CM, Racadio JM, McKinney DN, Racadio JM, Vu DN (2012) Varicocele and retrograde embolization with boiling contrast medium and gelatin sponges in adolescent subjects. J Vasc Interv Radiol 23(2):206–210

    Article  PubMed  Google Scholar 

  11. Rais-Bahrami S, Montag S, George AK, Rastinehad AR, Palmer LS, Siegel DN (2012) Angiographic findings of primary versus salvage varicoceles treated with selective gonadal vein embolization: an explanation for surgical treatment failure. J Endourol 26(5):556–560

    Article  PubMed  Google Scholar 

  12. Di Bisceglie C, Bertagna A, Baldi M et al (2007) Varicocele sclerotherapy improves serum inhibin B levels and seminal parameters. Int J Androl 30(6):531–536

    Article  PubMed  Google Scholar 

  13. Gazzera C, Rampado O, Savio L, Di Bisceglie C, Manieri C, Gandini G (2006) Radiological treatment of male varicocele: technical, clinical, seminal and dosimetric aspects. Radiol Med 111(3):449–458

    Article  CAS  PubMed  Google Scholar 

  14. Wunsch R, Efinger K (2005) The interventional therapy of varicoceles amongst children, adolescents and young men. Eur J Radiol 53(1):46–56

    Article  CAS  PubMed  Google Scholar 

  15. Fayad F, Sellier N, Chabaud M et al (2011) Percutaneous retrograde endovascular occlusion for pediatric varicocele. J Pediatr Surg 46(3):525–529

    Article  PubMed  Google Scholar 

  16. Gandini R, Konda D, Reale CA et al (2008) Male varicocele: transcatheter foam sclerotherapy with STS - outcome in 244 patients. Radiology 246(2):612–618

    Article  PubMed  Google Scholar 

  17. Granata C, Oddone M, Toma P, Mattioli G (2008) Retrograde percutaneous sclerotherapy of left idiopathic varicocele in children. Pediatr Surg Int 24(5):583–587

    Article  PubMed  Google Scholar 

  18. Li L, Zeng XQ, Li YH (2010) Safety and effectiveness of transcatheter foam sclerotherapy for testicular varicocele with a fluoroscopic tracing technique. J Vasc Interv Radiol 21(6):824–828

    Article  PubMed  Google Scholar 

  19. Siegel Y, Gat Y, Bacher GN, Gornish M (2006) A proposed anatomic typing of the right internal spermatic vein: importance for percutaneous sclerotherapy of varicocele. Cardiovasc Intervent Radiol 29(2):192–197

    Article  PubMed  Google Scholar 

  20. Jargiello T, Drelich-Zbroja A, Falkowski A, Sojka M, Pyra K, Szczerbo-Trojanowska M (2014) Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure. Acta Radiol. doi:10.1177/0284185113519624

    PubMed  Google Scholar 

  21. Kim J, Shin JH, Yoon HK et al (2012) Persistent or recurrent varicocele after failed varicocelectomy: outcome in patients treated using percutaneous transcatheter embolization. Clin Radiol 67(4):359–365

    Article  CAS  PubMed  Google Scholar 

  22. Reiner E, Pollak JS, Henderson KJ, Weiss RM, White RI Jr (2008) Initial experience with 3 % sodium tetradecyl sulfate foam and fibered coils for management of adolescent varicocele. J Vasc Interv Radiol 19(2 Pt 1):207–210

    Article  PubMed  Google Scholar 

  23. Palomo A (1949) Radical cure of varicocele by a new technique; preliminary report. J Urol 61(3):604–607

    CAS  PubMed  Google Scholar 

  24. Sangrasi AK, Leghari AA, Memon A, Talpur KA, Memon AI, Memon JM (2010) Laparoscopic versus inguinal (Ivanissevich) varicocelectomy. J Coll Physicians Surg Pak 20(2):106–111

    PubMed  Google Scholar 

  25. Hopps CV, Lemer ML, Schlegel PN, Goldstein M (2003) Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol 170(6 Pt 1):2366–2370

    Article  PubMed  Google Scholar 

  26. Kim SO, Jung H, Park K (2012) Outcomes of microsurgical subinguinal varicocelectomy for painful varicoceles. J Androl 33(5):872–875

    Article  PubMed  Google Scholar 

  27. Dubin L, Amelar RD (1970) Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 21(8):606–609

    CAS  PubMed  Google Scholar 

  28. Baehren W, Biehl C, Danz B (1992) Failed sclerotherapy trials with the V. spermatica interna. A retrospective analysis in 1141 patients with idiopathic varicocele. RöFo 157(4):355–360

    Google Scholar 

  29. Bechara CF, Weakley SM, Kougias P et al (2009) Percutaneous treatment of varicocele with microcoil embolization: comparison of treatment outcome with laparoscopic varicocelectomy. Vascular 17(Suppl 3):S129–S136

    Article  PubMed  Google Scholar 

  30. Iaccarino V, Venetucci P (2012) Interventional radiology of male varicocele: current status. Cardiovasc Intervent Radiol 35(6):1263–1280

    Article  PubMed  Google Scholar 

  31. Choi WS, Kim SW (2013) Current issues in varicocele management: a review. World J Mens Health 31(1):12–20

    Article  PubMed Central  PubMed  Google Scholar 

  32. Cayan S, Shavakhabov S, Kadioglu A (2009) Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl 30(1):33–40

    Article  PubMed  Google Scholar 

  33. Baehren W, Lenz M, Porst H, Wierschin W (1983) Side effects, complications and contraindications for percutaneous sclerotherapy of the internal spermatic vein in the treatment of idiopathic varicocele. RöFo 138(2):172–179

    Google Scholar 

  34. Riedl P, Kumpan W, Maier U, Stackl W, Lunglmayr G (1985) Long-term results after sclerotherapy of the spermatic vein in patients with varicocele. Cardiovasc Intervent Radiol 8(1):46–49

    Article  CAS  PubMed  Google Scholar 

  35. Kwak N, Siegel D (2014) Imaging and interventional therapy for varicoceles. Curr Urol Rep 15(4):399

    Article  PubMed  Google Scholar 

  36. Chan P (2011) Management options of varicoceles. Indian J Urol 27(1):65–73

    Article  PubMed Central  PubMed  Google Scholar 

  37. Kunnen M (1980) New techniques for embolisation of the internal spermatic vein: intravenous tissue adhesive (author's transl). Röfo 133(6):625–629

    CAS  PubMed  Google Scholar 

  38. Lord DJ, Burrows PE (2003) Pediatric Varicocele Embolization. Tech Vasc Interv Radiol 6(4):169–175

    Article  PubMed  Google Scholar 

  39. Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S (2000) Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 55(5):750–754

    Article  CAS  PubMed  Google Scholar 

  40. Watanabe M, Nagai A, Kusumi N, Tsuboi H, Nasu Y, Kumon H (2005) Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches. Int J Urol 12(10):892–898

    Article  PubMed  Google Scholar 

  41. Marmar JL, Kim Y (1994) Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol 152(4):1127–1132

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Marcus Treitl, MD. The authors of this manuscript declare relationships with the following companies: Marcus Treitl: Consultant for Covidien, Biotronik, Endoscout. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. None of the study subjects has ever been reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Institute for Clinical Radiology, Hospital of the Ludwig-Maximilians University of Munich, Nussbaumstr. 20, 80336, Munich, Germany

    Alma Ali, Stefan Wirth, Karla Maria Treitl & Marcus Treitl

Authors
  1. Alma Ali
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  2. Stefan Wirth
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  3. Karla Maria Treitl
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Correspondence to Alma Ali.

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Ali, A., Wirth, S., Treitl, K.M. et al. Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients’ satisfaction with regard to alternative techniques. Eur Radiol 25, 2889–2897 (2015). https://doi.org/10.1007/s00330-015-3684-5

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