Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study

Ficarra, Vincenzo; Porcaro, Antonio Benito; Righetti, Rita; Cerruto, M.A.; Pilloni, Stefania; Cavalleri, Stefano; Malossini, G.; Artibani, Walter

doi:10.1046/j.1464-4096.2001.02418.x

Cited by 37 publications

(37 citation statements)

References 25 publications

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“…Several studies have reported this to have a better diagnostic accuracy than physical examination, with the most widely accepted criteria for diagnosis being the presence of multiple veins greater than 3.0-3.5 mm in diameter with reversal of flow on Valsalva [6] . Spermatic venography is the "gold standard" for diagnosis but is primarily employed during intended treatment of varicocele, be it surgical or percutaneous [6,[9][10][11][12] . Reflux that lasts at least two seconds has been reported as equivalent to a positive venography result [1] .…”

Section: Discussionmentioning

confidence: 99%

“…Venography following surgical cannulation of a vein of the pampiniform plexus has been well described in the urology literature [9][10][11][12]17,18] , but is infrequently referred to in the radiology literature. In addition, there is little mention of the anatomy that is appreciated through venography by this route.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is little mention of the anatomy that is appreciated through venography by this route. Access to the pampiniform plexus is achieved through trans-scrotal cut-down and cannulation of a vein of the plexus [3,9,10] . Using this route, collateraliza- tion of the pampiniform plexus is appreciated from the external pudendal vein via the saphenofemoral route [12,17] .…”

Section: Discussionmentioning

confidence: 99%

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Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review

Gendel

Haddadin²,

Nosher³

2011

WJR

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Varicoceles are often treated with percutaneous embolization, using fibered coils and sclerosing agents, with the latter targeted at occlusion of pre-existing collateral veins. While various methods of surgical and embolization treatment are available, varicoceles may still recur from venous collateralization. We present a case, where following demonstration of complete occlusion of the right and left gonadal veins, direct puncture of the pampiniform venous plexus under ultrasound guidance revealed recurrent varicoceles supplied by anastomoses from the ipsilateral saphenous and femoral veins to the pampiniform plexus. In doing so, we describe a technique of percutaneous pampiniform venography in a case where the pertinent anatomy was not easily demonstrated by other methods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review

Gendel

Haddadin²,

Nosher³

2011

WJR

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“…In the end atoxysclerol mixed with air is injected. [2][3][4][5] This technique is well-established to treat varicocele. It is easier, faster and less invasive than open surgical and laparoscopic treatments.…”

Section: Introductionmentioning

confidence: 99%

Large bowel infarct following antegrade scrotal sclerotherapy for varicocele: A case report

Vicini

Pierro

Grande

et al. 2014

CUAJ

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Varicocele is the main cause of male infertility. Treatment stops continuous damage to spermatogenesis, thereby potentially improving fertility. Among all the available procedures, the antegrade scrotal sclerotherapy (ASS), a combined radiological-surgical approach first introduced by Tauber, is gaining more popularity due to its minimal invasiveness. We report the case of a 35-year old man who was subjected to a colonic resection after antegrade scrotal sclerotherapy for varicocele. The procedure was necessary due to the embolization of venous anastomosis between the spermatic and mesenteric veins, which were not detectable at the preoperative phlebography. IntroductionVaricocele represents the main cause of male infertility and leads to changes in testicular spermatogenesis in 60% to 70% of cases. Treatment prevents continuous damage to spermatogenesis, thereby potentially improving fertility. Successful treatment of varicocele improves semen quality in 40% to 60% of patients and recovers fertility in 10% to 40%.1 Among all the available procedures, the antegrade scrotal sclerotherapy (ASS) is a combined radiological-surgical approach first introduced by Tauber in 1988 2 and is usually performed under local anesthesia. The procedure starts with a short longitudinal scrotal incision at the base of the scrotum, isolation of the funiculum and identification of the most enlarged vein. Thereafter, a small incision of the vein allows for the insertion of a 23-gauge needle to perform a venogram by iodine contrast. In the end atoxysclerol mixed with air is injected. [2][3][4][5] This technique is well-established to treat varicocele. It is easier, faster and less invasive than open surgical and laparoscopic treatments.5 It results in a persistence rate as high as 9% in adults and 3% in children. 6 An analysis of seminal parameters showed a statistically significant improvement in the rate of fast progressive spermatozoa and reduction of immotile spermatozoa in patients who underwent ASS compared to open surgery. 5 Reported complication rates are low and they include scrotal hematoma, sterile epididymitis (due to paravascular application of the sclerosing agent), testicular atrophy (accidental sclerotherapy of the testicular artery), as well as intestinal 7 and abdominal wall necrosis (accidental sclerotherapy of the cremasteric artery). 2 Case reportA 35-year-old man presented with severe oligoasthenospermia and diagnosed with third grade varicocele on ultrasound. After we explained the therapeutic options to the patient, he agreed to undergo antegrade scrotal sclerotherapy. Incising the base of the scrotum, the funiculum was identified and the most enlarged vein was isolated and suspended between two slack sutures. A little incision of the vein was performed to insert a 23-gauge needle. The right position of the needle was checked by washing the vessel lumen with saline solution; the iodine contrast was then injected to perform a venogram (Fig. 1). Finally, during the Valsalva manoeuvre, 1 mL of air was injec...

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“…In the search for less traumatic treatment approaches, minimally invasive techniques such as laparoscopic varicocelectomy (LV), antegrade sclerotherapy (AS), and retrograde embolization (RE) were developed and have gained popularity during the last decade. A number of reports on these techniques used to treat series of pediatric or adult patients with varicoceles are available in the literature [1,7,12,19,21,22,25]. However, to our knowledge, no published study has evaluated the efficacy and complications of several minimally invasive procedures and their outcomes comparing the findings for children and adolescents with those for adults treated in the same institution.…”

mentioning

confidence: 99%

Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures

et al. 2006

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Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study

Cited by 37 publications

References 25 publications

Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review

Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review

Large bowel infarct following antegrade scrotal sclerotherapy for varicocele: A case report

Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures

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