Antegrade scrotal sclerotherapy for treating primary varicocele in children

Abstract

persistence rate of varicoceles and complications were compared with those using other techniques. RESULTSIn 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume ( < 75% testicular volume vs the normal side) confirmed by US. The mean ( SEM ) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty-four (97%) patients were eligible for follow-up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow-up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis). CONCLUSIONSAS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication. KEYWORDS varicocele, antegrade sclerotherapy, children, treatment OBJECTIVETo evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood. PATIENTS AND METHODSFrom December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9-18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left-sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow-up of 11 (3-60) months, and the operative duration, X-ray exposure time,

Initial experience with percutaneous selective embolization: A truly minimally invasive treatment of the adolescent varicocele with no risk of hydrocele development

“…However, as compared to our approach, the antegrade technique may be associated with an increased complication rate. Complications, including scrotal hematomas, epididymal-orchitis, recurrent testicular pain and testicular atrophy have been reported to occur in 3e5% of patients undergoing antegrade sclerotherapy [15,16,18].…”

Comparison of Inguinal Approach, Scrotal Sclerotherapy and Subinguinal Antegrade Sclerotherapy in Varicocele Treatment: A Randomized Prospective Study

“…The reported results of Tauber's technique show a recurrence rate of 9% in adults [3] . Another study showed 6 patients (7%) with recurrent varicocele, 4 of whom had been subjected to another sclerotherapy operation successfully [14] . Our recurrence rate for Tauber's technique was 17.65%.…”

Evolving management of adolescent varicocele

“…Being an entirely endovascular procedure, it does not carry any risk of hydrocele formation. Recurrence/persistence rate varies between 7% and 20% [20,23], a possible reason for recurrence being that this approach only addresses a possible reflux in the ISV.…”