Varicocele, conventional laparoscopic ligation versus occluding balloon embolization

Motta, Alessandro; Caltabiano, Giuseppe; Pizzarelli, Marco; Failla, Giovanni; Botezatu, Dragos; Muresanu, Horia; Foti, Pietro Valerio; Vignera, Sandro La; Condorelli, Rosita A.; Palmucci, Stefano; Basile, Antonio

doi:10.1007/s11547-018-0968-2

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…Previous evidence suggested that the prevention of excessive application of sclerosing agents into the scrotum might reduce the possibility of thrombophlebitis and patient discomfort. Motta et al 16 used tourniquet ligation on the upper part of the scrotum to prevent the sclerosing agent from possibly flowing back into the scrotum, reducing the possibility of phlebitis and scrotal pain in patients. As no contrast agent was added to the sclerosing agent during surgery, the possibility of the occurrence of abnormal embolization could not be completely ruled out.…”

Section: Discussionmentioning

confidence: 99%

Analysis of internal spermatic vein embolization through catheter versus laparoscopic high ligation in treatment of left varicocele

et al. 2020

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Objective Varicocele is a common disease in young and middle-aged men. This study aims to compare the efficacy of internal spermatic vein embolization of left varicocele versus laparoscopic high ligation. Methods From January 2017 to September 2018, a total of 69 varicocele patients were admitted and given the opportunity to choose the treatment option. Among these, 26 patients were treated with sclerosing agent injection, while 43 patients underwent laparoscopic surgery. They were followed up for 12 months after surgery, and the technical success rate, recurrence rate, complication rate, cost, operative time, and hospitalization time with regard to these two methods were analyzed. Results All patients completed the medical procedures. There was no recurrence in patients in the sclerotherapy group during the follow-up period; however, the complication rate was 19.2%. Furthermore, the operative time, hospitalization time, and cost of treatment were 31.1 ± 11.1 min, 1.2 ± 0.49 days, and 9613.11 ± 895.97 Yuan, respectively. In the laparoscopic group, 9 patients underwent laparoscopic bilateral high ligation, while 34 patients received treatment on the left side alone. The recurrence rate of left varicocele was 4.7% and the complication rate was 44.2%. Furthermore, the operative time, hospitalization time, and treatment cost were 50.4 ± 14.48 min, 4.0 ± 2.02 days, and 10,948.29 ± 2547.00 Yuan, respectively. Moreover, there were statistically significant differences ( P < 0.05) in operative time, hospitalization time, and treatment cost. Patients in the sclerotherapy group had an advantage with respect to the overall complication rate when compared with patients from the laparoscopic group ( X2 = 4.448, P < 0.05), and there was a statistically significant difference in hydrocele ( X2 = 4.555, P < 0.05). However, there was no significant difference in the recurrence rate between these two groups ( X2 = 1.245, P > 0.05). Conclusion Patients who underwent sclerotherapy showed a higher technical success rate, a lower recurrence rate, fewer complications, and shorter hospitalization time compared to those treated with laparoscopic ligation. Transcatheter sclerosing agent injection may be a preferable treatment option for patients with unilateral varicocele.

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Section: Discussionmentioning

confidence: 99%

Analysis of internal spermatic vein embolization through catheter versus laparoscopic high ligation in treatment of left varicocele

et al. 2020

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“…Twenty studies compared surgical ligation and sclero‐embolization in patients with varicocele. There were three prospective non‐randomized studies (Nasr et al, 2017; Nasser et al, 2020; Sepúlveda et al, 2018), five randomized clinical trials (Bolla, 2014; Nieschlag et al, 1993; Sayfan et al, 1992; Yavetz et al, 1992; Zucchi et al, 2005), and 12 retrospective studies (Bechara et al, 2009; Beutner et al, 2007; Dewire et al, 1994; Feneley et al, 1997; Jing et al, 2020; Mazzoni et al, 1999, 2001; Mongioì et al, 2019; Motta et al, 2019; Parsch et al, 1990; Shlansky‐Goldberg et al, 1997; Wickham et al, 2021).…”

Section: Evidence Synthesismentioning

confidence: 99%

Do sclero‐embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta‐analysis

Fabiani

Pavia²,

Stramucci

et al. 2022

Andrologia

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We aimed to systematically review complications, and recurrence rate of varicocele treatment by comparing the surgical ligature versus sclero-embolization techniques in children, adolescents and adults. The secondary outcomes were the evaluation of semen parameters and spontaneous pregnancy rate in adults. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05. Twenty studies were included. Incidence of postoperative hydrocele was significantly higher in the surgical ligation group (OR 3.06 95% CI 1.06-8.88, p = 0.04). Incidence of postoperative orchiepidydimitys was significantly higher in sclero-embolization group (OR 0.26 95% CI 0.08-0.85, p = 0.02). Presence of normal spermatozoa was significantly higher sclero-embolization group compared with the surgical ligature group (MD 2.54% 95% CI 0.43-4.65, p = 0.02). No difference was found in overall complications, wound infection, testis pain, surgical site hematoma, total sperm count, sperm motility, pregnancy and recurrence rate. This review confirms that current data does still not support the superiority of one type of treatment over other ones.

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“…Single or bi-institutional retrospective studies have shown no difference in success rates, complications, sperm quality, pregnancy rate, or overall satisfaction rates between surgical ligation and percutaneous embolization. [57][58][59][60] A review in 2012 comparing various surgical and radiologic techniques found antegrade sclerotherapy and a subinguinal approach to have the most efficacy when looking at outcomes, complication rate, and cost-effectiveness. 14 Most recent systematic reviews published between 2021 and 2022 reveal that radiologic and surgical treatments for varicocele show low certainty evidence of similar rates in recurrence and pregnancy outcomes, with radiologic treatment showing lower complication rates compared to surgical treatment.…”

Section: Radiological Versus Surgical Interventionsmentioning

confidence: 99%

Varicoceles: Overview of Treatment from a Radiologic and Surgical Perspective

Silva

Meller

Ogundipe

et al. 2022

Semin intervent Radiol

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A testicular varicocele is the result of the expansion of the venous pampiniform plexus of the scrotum. Often painless, a significant number of patients experience orchialgia, swelling, testicular atrophy, and abnormalities in spermatic parameters. Treatment of symptomatic varicocele involves a radiologic or surgical intervention to obstruct the reflux of venous drainage. Testicular anatomy, diagnostic evaluation and imaging, options for surgical intervention, and a step-by-step description of retrograde embolization and antegrade scrotal sclerotherapy are discussed. Furthermore, included is an overview of postprocedural management and patient outcomes for radiological interventions, and the most up-to-date evidence on the efficacy of varicocele treatments as well as how they compare to each other.

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Varicocele, conventional laparoscopic ligation versus occluding balloon embolization

Cited by 8 publications

References 14 publications

Analysis of internal spermatic vein embolization through catheter versus laparoscopic high ligation in treatment of left varicocele

Analysis of internal spermatic vein embolization through catheter versus laparoscopic high ligation in treatment of left varicocele

Do sclero‐embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Results from a systematic review and meta‐analysis

Varicoceles: Overview of Treatment from a Radiologic and Surgical Perspective

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