Persistent or recurrent varicocoele after failed varicocoelectomy: Outcome in patients treated using percutaneous transcatheter embolization

Kim, J.; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi‐Young; Gwon, Dong Il; Kim, E.Y.; Sung, Kyu‐Bo

doi:10.1016/j.crad.2011.10.007

Cited by 38 publications

(25 citation statements)

References 23 publications

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“…Unfortunately, there are no data to support this assumption, as studies encompassing surgically-treated varicocele patients with presurgical because venography are lacking. (21,23,26) Our results indirectly support the above-mentioned hypothesis, showing the most common anatomic variations in patients with recurrent varicoceles after failed surgery. In our group, the majority of patients (22; 66%) were classified as type 3 -with the GV duplications.…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2015

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Section: Discussionsupporting

confidence: 88%

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

et al. 2015

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“…There were no further recurrences after redo varicocelectomy in the current study. Although many urologists recommend embolization following a failed surgical varicocelectomy, the method has 5.8-20% recurrence rates 14,21-23. In contrast, however, subinguinal microscopic repair of recurrent varicoceles has a recurrence rate of 2% 21.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

et al. 2012

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PurposeTo investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy.Materials and MethodsThe present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins.ResultsSeven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy.ConclusionPatent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.

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“…This was done to reflect a possible decreased success rate in patients already demonstrating a predilection to recurrence as previously described. 23,24 Estimated pregnancy rates following NMV, MV and PE were 30.1%, 44.8% and 31.9%, respectively (Table 2b). In simulations where a secondary treatment was required for recurrence, the pregnancy rate was estimated as the lesser of the primary and secondary procedure types.…”

Section: Probability Estimatesmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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Introduction: Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. Methods: A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Results: Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. Conclusions: MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

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Persistent or recurrent varicocoele after failed varicocoelectomy: Outcome in patients treated using percutaneous transcatheter embolization

Cited by 38 publications

References 23 publications

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

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

Recurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

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