Treatment of Idiopathic Varicoceles by Transfemoral Testicular Vein Occlusion

Weißbach, L.; Thelen, M.; Adolphs, H.-D.

doi:10.1007/978-3-642-68066-3_35

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…A wide variety of percutaneous techniques has been developed for routine use on an outpatient basis without anesthesia. [1][2][3][4][5][6][7][8][9] Results of the radiological methods are similar to those of surgical ligation. 10 We started with sclerotherapy in 1978 and had an 84% overall rate of regression of varicoceles.…”

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confidence: 76%

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Cyanoacrylate in Spermatic-Vein Embolization

Kumpan¹,

Riedl²,

J³

et al. 1984

Semin intervent Radiol

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Six years ago, interventional radiologists became involved in transfemoral therapeutic blockade of spermatic veins for varicocele treatment. A wide variety of percutaneous techniques has been developed for routine use on an outpatient basis without anesthesia. [1][2][3][4][5][6][7][8][9] Results of the radiological methods are similar to those of surgical ligation. 10 We started with sclerotherapy in 1978 and had an 84% overall rate of regression of varicoceles. 6,11 Small veins (< 8 mm in diameter) could be obliterated easily, but in larger veins, sclerotherapy sometimes proved unsuccessful. Since 1981, therefore, we have been investigating the clinical use of Bucrylate (isobutyl-2-cyanoacrylate = IBC; Ethicon), alone and in combination with Aethoxysklerol (hydroxypolyethoxydodecan; Kreussler) in 60 patients using a modified technique which was originally described by Kunnen. 5,12 PATIENTS AND METHODSA total of 75 patients underwent diagnostic spermatic venography. Embolotherapy of the left spermatic vein with IBC was accomplished in 60 patients, 13 to 39 years of age, with a mean of 25 years; bilateral vein occlusion was performed in 11 (18%). Patients were evaluated by thorough physical examination, contact thermography, and spermatic venography. In 42% of the cases, a grade III (>2 cm in diameter 13 ) varicocele was present, in 32% a grade II, and in 21% a grade I. Three patients (5%) had subclinical varicoceles. Semen analysis was performed at the Urological Clinic and will not be discussed in this report. In our patients, only 36% had a wish to father a child. In nine patients (15%), a varicocele was recurrent after surgical suprainguinal ligation.The veins ranged in diameter from 4 to 12 mm, with an average width of 7.5 mm, measured at the point of occlusion. Half of our patients demonstrated vein diameters of 4-7 mm, 37% from 8-9 mm, and 13% from 10-12 mm. There were three types of venous branching: 2 Type A: a single vein with fine ramifications in the proximal third (20%); Type B: a vein accompanied by several parallel venous channels up to 2 mm in diameter (37%); and Type C: numerous branches along the entire course of the spermatic vein (43%).In the majority of the cases (78%), one IBC plug was applied for complete venous occlusion. Four patients were given a double IBC dose. Thirteen patients with vein diameters of 10 to 12 mm and significant collateral vessels represented a "potential-recurrence" group and were treated with IBC and 2-4 ml of 4% Aethoxysklerol as a second occlusive mechanism in the same angiographic session.Three days after the procedure, patients were reexamined clinically and by thermography. Examination was repeated after 1, 6, 12, and 24 months; and suspected failures were reevaluated by venography. TECHNIQUEPatients were placed on a tilting table, and spermatic venograms were performed via the left femoral vein under local anesthesia. First, an attempt was made to selectively demonstrate the right spermatic vein. Mostly, this was accomplished with the use of a sidewinder-2-type ...

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confidence: 76%

“…Sclerotherapy, our original technique, 2,6,11 is simple, easy to perform, inexpensive, and less time-consuming than any comparable method. 4,5,7,8,12,15 It is, however, less effective when applied in large veins. Statistically, this constitutes the main reason for our 16% partial-success rate with Aethoxysklerol alone.…”

Section: Discussionmentioning

confidence: 99%

Cyanoacrylate in Spermatic-Vein Embolization

Kumpan¹,

Riedl²,

J³

et al. 1984

Semin intervent Radiol

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“…The target in varicocele surgery is to ligate the branches of the internal and external spermatic veins by maintaining the lymphatic vessels and artery within the spermatic cord. Since occlusion of the small collateral veins is not possible, recurrence in this method has been reported to be 4-11% [10][11][12]. In the inguinal and subinguinal microsurgery technique, the arteries and lymphatic vessels are mostly preserved and the other vascular structures are visualized more clearly; therefore, recurrence and complications are rather rare in these methods [13,14].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Efficacy of Microscopic Varicocelectomy in the Treatment of Primary and Recurrent Varicocele

2018

J Androl Gynaecol

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Objectıve: Varicocele is the most common and correctable cause of male infertility. Microscopic subinguinal varicocelectomy is the golden standard in the treatment of this disease, and recurrence is the most common complication. The aim of this study was to investigate the outcomes of microscopic varicocelectomy in primary and recurrent varicocele. Materıals and Method:The data of 20 patients undergoing left subinguinal microscopic varicocelectomy due to left varicocele for the first time and 20 patients undergoing the same operation for the second time due to recurrence between April 2015 and May 2017, were retrospectively evaluated. Semen analyses, testicular volumes and complication rates were compared between the groups both prior to and 12 months after the operation. Fındıngs:The mean age was 30.2±1.4 in the primary varicocele group and 31.3±1.1 in the recurrent varicocele group (p>0.05). No significant difference was observed between the pre-and the postoperative values of testicular volume in patients undergoing primary microscopic varicocelectomy (3.2±1.4 ml and 3.1±1.7 ml, respectively; p>0.05); however, a significant improvement was observed in sperm count, motility and morphology parameters (10.3±2.9 millions/ml, 28.2±7.8%, 2.2±1.4% and 11.3±3.3 millions/ml, 30.2±6.8%, 2.5±1.8%, p<0.05).In the recurrent varicocele group, no significant difference was observed between the pre-and post-operative semen volume (3.23±1.7 ml and 2.4±1.6 ml, p>0.05), whereas a significant improvement was observed in sperm concentration, morphology and motility parameters (9.6±3.3 millions/ml, 20.3±4.5%, 2.3±1.7% and 11.6±2.6 millions/ml, 23.2±7.5%, 2.5±1.9%, p<0.05). The testicular volume was observed to have increased in the post-operative period in both primary and recurrent varicocele groups (12.5±2.6 ml and 13.2±3.4 ml vs. (11.8±2.4 ml and 12.3±2.7 ml), which was not statistically significant (p>0.05).Conclusıon: Microscopic subinguinal varicocelectomy, which is related to the highest success rates and lowest recurrence and complication rates in the treatment of varicocele, may be safely used in the treatment of recurrent varicocele as well.

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“…The standard therapy of spermatic varicocele has been ligation of the internal spermatic vein (ISV) by the inguinal or retroperitoneal approach; recently, angiographic techniques for retrograde catheterization of the ISV have been described 2 -3 ). Since then, several nonsurgical methods for occlusion of varicoceles including detachable balloons 4 -7 ) , sclerosing agents S -9 ) ' and steel coils [10][11][12][13] have been introduced on an outpatient basis , avoiding the increased morbidity and expense of surgery.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous coil embolization in the management of spermatic varicocele

Yang¹,

Park²

1987

J Korean Radiol Soc

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Percutaneous occlusion of the internal spermatic vein is a new, safe, and effective alternative therapy to surgical li gation in the treatment of spermatic va ricocele. Em bolization with stainl ess steel coil s was done on 10 patients wi th symp tom atic spermatic varicocele immediately alter diagnostic venograph y. The results 01 these procedures we re assessed by clin ical improvement of symptoms and objective diminution 01 the d il ated pampiniform plexus demonstrable us ing scrotal ultrasonography In one pati ent w ith single coil occl usion had a rec urrence, and the other 9 patients showed both cl ini ca l and ultrasonographic improvements of the va ricocele Percutaneous emboli za tion w ith stee l co il s appeared to be effective w ithout majo r co mplications and the savings of hospitalization an d general anesthes ia are important additional merits 01 this method being performed in the radiologic department on an ou tpatient basis Key Words: Va ricocele, Pe rcuta neous em boli zation, co il 이 논운은 1 987 년 7 월 23 일에 접수히여 1 987 년 8 월 1 9 일에 채택되었음.

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Treatment of Idiopathic Varicoceles by Transfemoral Testicular Vein Occlusion

Cited by 3 publications

References 5 publications

Cyanoacrylate in Spermatic-Vein Embolization

Cyanoacrylate in Spermatic-Vein Embolization

Evaluating the Efficacy of Microscopic Varicocelectomy in the Treatment of Primary and Recurrent Varicocele

Percutaneous coil embolization in the management of spermatic varicocele

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