MP55-05 NOVEL HYBRID PEDIATRIC VARICOCELE TECHNIQUE COMBINING SURGICAL VENOUS ACCESS WITH VENOGRAPHIC ROAD MAP DIRECTED ANTEGRADE COILING AND ADJUNCT SCLEROTHERAPY

Abstract

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-05 NOVEL HYBRID PEDIATRIC VARICOCELE TECHNIQUE COMBINING SURGICAL VENOUS ACCESS WITH VENOGRAPHIC ROAD MAP DIRECTED ANTEGRADE COILING AND ADJUNCT SCLEROTHERAPY David Strauss, Laura Kidd, Raphael Yoo, David Goldstein, and Gregory Dean David StraussDavid Strauss More articles by this author , Laura KiddLaura Kidd More articles by this author , Raphael YooRaphael Yoo More articles by this author , David GoldsteinDavid Goldstein More articles by this author , and Gregory DeanGregory Dean More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal surgical management of varicoceles remains controversial and debated. Various approaches to varicocelectomy, including open, laparoscopic, and minimally invasive techniques, have been described. We combine open surgical scrotal venous access with venography directed antegrade coiling with adjunct sclerotherapy. We believe that this offers multiple advantages including avoiding IR access through the jugular or femoral vein with targeted access only into the affected gonadal vessels. This approach also enables treatment of vascular variants which might be inadequately treated through alternative approaches. METHODS: All patients were aged 13-16. All patients had a grade 3 varicocele on exam. Our technique employs open scrotal access completed by the urological surgery team through a horizontal sub-inguinal incision followed by transection of a dilated vein. The distal end is ligated for vascular control, and the proximal end is cannulated in conjunction with the interventional radiologist. A road map venogram is performed to confirm standard vascular anatomy of the left gonadal vessels. The entire gonadal vein is coiled, and adjunct sclerotherapy performed. Accessory drainage routes are identified and additionally coiled. (Figure 1) The patients were followed postoperatively. RESULTS: Six patients were treated in this manner. There were no intraoperative complications or 30-day complications. All patients had initial postoperative visit within 3 months of the procedure, and none had detectible varicoceles. All patients remain without varicocele recurrence with short and median term follow up (median 13.5 months). Of note, aberrant drainage to the ipsilateral and contralateral internal iliac / hemiazygos systems were identified and treated in two patients. CONCLUSIONS: A combined approach comprised of scrotal access with venous cannulation followed by venographic roadmap directed antegrade coiling and adjunct sclerotherapy is an effective option for treatment of pediatric varicoceles. By performing concurrent venography, vascular variants can be addressed with the potential to decrease recurrence. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e959-e960 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Strauss More articles by this author Laura Kidd More articles by this author Raphael Yoo More articles by this author David Goldstein More articles by this author Gregory Dean More articles by this author Expand All Advertisement Loading ...