Antegrade Sclerotherapy to Treat All Types of Varicoceles in the Pediatric Population: Experience of a Single Center

Abstract

To analyze our experience with antegrade sclerotherapy for the treatment of Coolsaet types I, II, and III varicoceles in a pediatric and adolescent population. Between 2005 and 2015, 73 patients who underwent antegrade sclerotherapy were retrospectively evaluated. Patient age, side, clinical and Doppler ultrasound grade, and anatomical variations were collected. Varicoceles were grouped following Coolsaet's classification: all types were sclerosed. Follow-up consisted in clinical examination 3 and 6 months following surgery and testicular Doppler ultrasound 6 and 12 months following surgery. Patients were then telephonically interviewed. Success was defined as varicocele resolution or reduction to a grade not requiring surgery. Mean patient age was 14.7 years and mean operating time was 50.8 minutes. Based on phlebographic imaging and following Coolsaet's classification, we identified 57 (78.1%) type I, 3 (4.1%) type II, and 13 (17.8%) type III varicoceles. No intraoperative complications were observed. Three patients (4.1%) presented a short-term complication in the form of pampiniform plexus thrombosis; 1 patient also developed wound dehiscence: all complications occurred in Coolsaet type I varicoceles and during surgeon learning curve. No hydrocele occurred. Out of 59 patients with a satisfactory follow-up (range: 14 months-10 years), 2 recurrences occurred, the success rate thus being 96.6%. Tauber's antegrade sclerotherapy is a simple and feasible technique, effective in treating all kinds of varicocele with low complication, recurrence, and persistence rates. Phlebography reveals frequent venous anatomical variations, allows grouping of varicoceles into Coolsaet types, and enables performing of sclerosis safely in all 3 kinds.