CIRSE Standards of Practice on Varicocele Embolisation

A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting

“…By showing both favourable system and individual costs in this study and given several studies have shown that embolisation improves the rate of subsequent fertility, it should be stressed that embolisation is a first-line option for men which should be presented to them as part of all informed consent processes where any varicocoele treatment is being considered. 7 However, for this to be realised, patients must have established pathways to access these services. This means interventional radiologists (IRs) must practise as full-time clinicians with outpatient clinics and hospital admitting rights, and where the specialist healthcare journey is managed by the IR specialist after the initial consultation.…”

“…At our institution, we use a coil-sclerotherapy approach to embolisation via a sandwich technique. 7,8 Venotomy via either the internal jugular or femoral vein is at operator discretion and treatment is preferred through an 0.035 00 system using fibred pushable coils (Cook Nester or Tornado, Cook Medical, Bloomington, IN, USA) and 3% aethoxysklerol made to a foam using 1:1 dilution with air (Polidocanol, Getz Healthcare, Lane Cove, NSW, Australia). If anatomy is complex, an 0.018 00 system is used.…”

“…[4][5][6] Varicocoele repair may be achieved through many different techniques including laparoscopic surgery, microsurgery and embolisation. 4,7 There are different approaches to embolisation including using a range of embolic agents such as coils, sclerotherapy and N-Butyl-Cyanoacrylate (NBCA). 7,8 There are potential advantages and disadvantages of each repair technique.…”

“…4,7 There are different approaches to embolisation including using a range of embolic agents such as coils, sclerotherapy and N-Butyl-Cyanoacrylate (NBCA). 7,8 There are potential advantages and disadvantages of each repair technique. Some advantages of embolisation are that it does not require general anaesthetic and offers patients an option with early return to work.…”

“…Some advantages of embolisation are that it does not require general anaesthetic and offers patients an option with early return to work. 7,8 However, it has also been suggested that varicocoele embolisation may be low cost. [9][10][11] A 1994 study from Dewire et al assessed costs of 81 patients who underwent repair by either embolisation or surgery.…”