Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure

Jargiełło, Tomasz; Drelich-Zbroja, Anna; Falkowski, Aleksander; Sojka, Michał; Pyra, Krzysztof; Szczerbo-Trojanowska, Małgorzata

doi:10.1177/0284185113519624

Cited by 40 publications

(51 citation statements)

References 28 publications

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“…However, collateral venous drainage has been demonstrated to play a role in some adult series 12,13 . One retrospective review divided patients based on age (<17 years & >25 years) and the adolescent left ISVs were more likely to be incompetent (86% vs 72%), more likely to have a single ISV outflow (94% vs 72%), and have less collateral venous drainage (56% vs 71%) 12 .…”

Section: Etiologymentioning

confidence: 99%

The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?

2017

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The primary indication for varicocele repair in adults, that of failed paternity, must be substituted in the adolescent population with surrogate parameters of testicular size differential and semen analysis. Making recommendations based on these two parameters is incredibly difficult because studies often have contradictory findings, different patient populations, and lack of long term follow up of the key endpoint, paternity. Therefore, it is not a surprise that recommendations for adolescent varicocele repair are general (with some exceptions) and necessarily so because of limitations in quality of evidence. Apart from pain, all indications for varicocele repair in adolescence remain controversial. This highlights the most important task for future studies: to prevent pediatric urologists from allowing a potentially damaging process to go untreated, while at the same time avoiding unnecessary intervention on a highly prevalent condition.

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Section: Etiologymentioning

confidence: 99%

The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?

2017

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“…In addition, although such complications are rare, embolization carries a risk of contrast reactions, extravasation, and migration of the embolization material [6768]. This procedure is less commonly used as a first-line treatment for varicoceles, but it has been found to exhibit an excellent success rate in the setting of recurrent varicoceles after surgical repair [69]. …”

Section: Treatment Of Varicocelesmentioning

confidence: 99%

Clinical Outcomes of Varicocele Repair in Infertile Men: A Review

Chiba

Fujisawa

2016

World J Mens Health

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Varicoceles are a major cause of impaired spermatogenesis and the most common correctable cause of male infertility. They are found in approximately 40% of men with primary infertility and 80% of men with secondary infertility, although they also occur in 12% of men with normal semen parameters. The presence of a varicocele does not always affect spermatogenesis, as it has been reported that only 20% of men with documented varicoceles suffer fertility problems. However, varicocele repair appears to have beneficial effects in men with impaired semen parameters and palpable varicoceles. Currently, the main procedures employed for varicocele repair are microsurgical subinguinal or inguinal varicocelectomy, laparoscopic varicocelectomy, and radiological percutaneous embolization. Microsurgical varicocelectomy appears to be the optimal treatment in most cases, whereas the other procedures are useful only in specific cases. After treatment, it typically takes 3 to 6 months for patients' semen parameters to improve; thus, other therapies, including assisted reproductive technology, should be considered if infertility persists after this interval, especially in older couples. Controversies still remain regarding how varicoceles in certain subgroups, such as adolescents or men with azoospermia, should be treated. Due to their relatively high prevalence rate among the general population, varicoceles can occur concomitantly with other conditions that cause impaired spermatogenesis. Further studies are necessary in order to identify the patients who are most likely to benefit from treatment. In this review, we sought to summarize the issues currently associated with varicocele treatment in infertile men.

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“…Follow-up revealed a clinical success rate of 83.9% and a persistence or relapse rate of 16.1%. The lowest relapse rate reported in the literature comes from the study by Jargiello et al, who used 3% aethoxysclerol with fibered coils (19). The highest relapse rates were reported in studies by PucheSanz et al (8) and Wunsch et al (20), who used fibered coils alone and aethoxysclerol alone in various concentrations, respectively.…”

Section: Discussionmentioning

confidence: 96%

Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate

Loffroy¹,

Mourey²,

Genson³

et al. 2016

Journal of Vascular and Interventional Radiology

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Background: To evaluate pain, radiation and recurrence rates in patients undergoing varicocele embolization with three different embolic materials.Methods: Retrospective study of 182 consecutive patients who underwent transcatheter retrograde varicocele embolization from July 2011 to May 2015 with glue (Glubran ® 2) (group 1, n=63), mechanical agents (coils and/or plugs) (group 2, n=53) or a sclerosing agent (polidocanol) (group 3, n=66). Patients were asked by telephone interview to evaluate pain during embolization and at 1, 7 and 30 days using a quantitative pain scale ranging from 0 to 10. Duration of scopy, kinetic energy released per unit mass (kerma) and dose area product (DAP) were assessed as radiation parameters during embolization procedures.Recurrence rates after treatment were also evaluated. Statistical analyses were performed using parametric and non-parametric tests.Results: Patients in the three study groups were comparable for age, clinical indication and embolization side. No difference was noted for significant pain (pain score ≥3) during embolization and at 1, 7 and 30 days after treatment. Discomfort (pain score <3) was more frequent in group 1 than in groups 2 and 3 at 7 days after the procedure (P=0.049). No difference in discomfort was noted during embolization or at 1 and 30 days. Duration of scopy was shorter (P<0.0001) and kerma was lower (P=0.0087) in group 1 than in groups 2 and 3. DAP was lower in group 1 than in group 2 (P=0.04) but no difference was noted between groups 1 and 3, and groups 2 and 3. The recurrence rate at a mean follow-up of 24.4 months (range, 2-53 months)was significantly lower in group 1 than in the two other groups (P=0.032).Conclusions: The use of Glubran ® 2 acrylic glue for varicocele embolization is safe and leads to less radiation and lower recurrence rates than is the case for other embolic materials without any more significant pain.

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Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure

Abstract: Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.

Cited by 40 publications

References 28 publications

The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?

The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?

Clinical Outcomes of Varicocele Repair in Infertile Men: A Review

Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate

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