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

Abstract

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.

Liquid and Solid Embolic Agents in Gonadal Veins

“…Radiologic treatment offers the advantages of causing less patient discomfort and rapid recovery in comparison to the more invasive approach of varicocelectomy [20]. Endovascular treatment offers a lower cost and a lower recurrence rate than surgery and prevents the incision and splitting of the abdominal muscles [14,[21][22][23][24].…”

“…Sclerotherapy with polidocanol presented higher pregnancy rates than surgical treatment options and has the advantage of no association with hydrocele [25]. Transcatheter embolization with sclerosing agent can be considered the most effective and safe procedure for treatment of MV and may be the preferable treatment option for patients with unilateral varicocele [23].…”

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

“…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).…”