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Clinical and sub-clinical varicoceles are associated with infertility and abnormal sperm parameters. Percutaneous embolization is a minimally invasive, safe, outpatient method of treatment which is cost effective in comparison to surgery. This study is a retrospective review of embolization of the spermatic vein using stainless steel occluding spring coils, performed in 116 males from two infertility clinics. Follow-up results were complete in 87 patients of which 79 (91%) were successful both technically and clinically and all had sperm analysis performed both before and within 2 years after embolization. There was a highly significant increase in motility (mean 35% before, mean 46% after, p < 0.001). Sperm density showed a trend towards improvement, but only p < 0.10, and there was no significant change in semen volume or morphology. The partners of 29 men (33%) became pregnant in a total of 241 years of follow-up.

Meningiomas rarely give rise to metastases despite frequent dural invasion. A rare case of symptomatic hypoglycaemia due to extensive liver metastases from an angioblastic meningioma is described along with the use of hepatic arterial chemo-embolization to effect palliation by reduction in tumour bulk.

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We are grateful to Dr Marsman for his comments about our recent paper [1]. We did not analyse the results for clinical and subclinical vancoceles separately. Patients were referred for embolization with the diagnosis of a left sided varicocele, based on a clinical examination and utilizing Doppler ultrasound where necessary, associated with abnormal semen analysis and infertility. Venography is undertaken as part of the embolization procedure and not for diagnostic purposes. Indeed, a proximal competent valve can still be associated with a Varicocele related to more distal Venous incompetence and collateral venous pathways [2], which can only be abolished by distal embolization.