Primary treatment of painful varicocoele through percutaneous retrograde embolization with fibred coils

Abstract

SUMMARYThe literature on the treatment of painful varicocoele is limited, likely because of the short period since it was recognized as a clinical entity and the limitations posed by the subjectivity of pain. Our aim was to systematically analyse the results of percutaneous embolization as the chosen treatment for this condition. We conducted a retrospective study of patients undergoing percutaneous embolization as primary treatment for painful varicocoele from January 2007 to November 2013. Radiologic and ultrasonographic successes were evaluated according to the existence or absence of venous reflux on venography after embolization and on Echo Doppler control at 3-6 months. Clinical success was assessed by Visual Analog Scale pain questionnaires before surgery and at 3-6 months; in addition, at the time of the study, telephone interviews were conducted to update the clinical situation and development. A total of 154 patients received operations. The median pain before surgery, at 3-6 months and at the time of interview was 7, 1 and 0 points respectively (p < 0.001). The ultrasonographic success rate at 3-6 months was 68.6%. With a median follow-up of 39 months, the success and relapse/clinical persistence rates were 86.9 and 13.1% respectively. By studying the degree of agreement between clinical success and ultrasonographic success, a kappa index = 0.443 was obtained. Patients with success recounted greater pre-operative pain scores than those who relapsed or persisted (7.5 vs. 5.0; p = 0.004). In patients with painful varicocoele, the ultrasonographic recurrence of venous reflux does not imply the recurrence of pain; hence, the proper assessment of success in these patients should include a systematic assessment of their pain and grade of reflux. Percutaneous retrograde embolization as a primary treatment for painful varicocoele is a clinically effective option with a high success rate that can be maintained in the long term, especially in patients with high pre-operative pain.

Adolescent varicocele: A large multicenter analysis of complications and recurrence in academic programs

“…[21] However, in a retrospective study of PE for varicocelectomy of painful varicoceles in 181 adult patients between 2007 and 2013, Puche-Sanz reported a 4.5% incidence of hydrocele diagnosis in a 39 month follow up period. [22] The present series is consistent with Puche-Sanz in detecting a 5% rate of hydrocele detection after PE, which is equivalent to the 4.5% rate after open varicocelectomy. PE has been held out as the ideal lymphatic sparing approach and therefore should not result in hydrocele formation.…”

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

“…Indeed, percutaneous embolization has the advantage of being an outpatient procedure with a faster return to normal activities, a considerably lower cost and a lower recurrence rate than is the case for surgery (6). The use of many different embolic agents, such as gelatin sponge, stainless steel coils, Amplatzer vascular plugs, detachable balloons, cyanoacrylate glues or sclerosing agents has been reported (7)(8)(9)(10)(11)(12)(13)(14)(15). However, to our knowledge, there are no data in the literature regarding the comparison of the different embolic materials currently available on the market for the treatment of varicocele in terms of efficacy, tolerance, radiation and recurrence rates.…”

“…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. As suggested by some authors, a combination of sclerotherapy and embolization could provide better results (21).…”

“…Among the endovascular methods, coils are the most commonly used because they are safe, easy to handle and readily available (8,17). Amplatzer vascular plugs may be used as an alternative to coils (18).…”

A review of varicocele repair for pain

“…Complications included technical difficulties such as “venous valves, venous rupture, coil displacement, etc.” in 4.5% and failure to complete the procedure in an additional 4.5% (for a total 9% considered to have technical difficulty or failure), and hydrocele in 5% (23). Despite these results, embolization is typically reserved for treatment of recurrent varicocele after surgical repair when the anatomy causing the varicocele needs to be radiographically defined (8,24-26).…”