Antegrade Sclerotherapy Research Articles

325 Antegrade Sclerotherapy: A Viable Option for the Treatment of Varicocele in the United Kingdom? a Single Centre Perspective

Abstract Aim Antegrade sclerotherapy has been used for the treatment of varicoceles since the 1970s. Despite its efficacy, minimally invasive technique, and short learning curve it is not routinely used in the United Kingdom. With the prospect of an increase in varicocele operations, with the European and American Associations of Urology now advocating for treatment in sub-fertile men with clinical varicoceles, we aim to look at the experiences of this procedure in a UK urology unit. Method A retrospective review of antegrade sclerotherapy for varicoceles within a single centre in North Wales. The primary outcome being clinical recurrence and secondary outcomes of fertility and radiation exposure. Results 37 patients with a median age of 28 (range 14-65) were included. 35 out of 37 patients had a reported pre-operative scrotal ultrasound showing a left sided varicocele. The most common indication for procedure was pain (70.3%) followed by subfertility (21.6%). 45.9% were exposed to only 1 shot of radiation during the procedure. The median follow up was 3 months and only 2 patients had clinical recurrence and there were no significant complications (Clavien-Dindo > 3). 3 of 8 patients with subfertility had successful paternity. Another 4 patients had semen analysis, all of them had improved sperm count, motility, morphology postoperatively. Conclusions Antegrade sclerotherapy shows favourable outcome of only 5.4% recurrence accompanied with low dose of radiation. 37.5% of sub fertile patient managed to achieve paternity. This is another viable treatment option for consideration in the treatment of varicoceles.

Radiation Exposure and Surgical Outcomes after Antegrade Sclerotherapy for the Treatment of Varicocele in the Paediatric Population: A Single Centre Experience.

Antegrade sclerotherapy (Tauber) effectively treats varicocele. However, fluoroscopy exposes young males to ionizing radiation. We aimed to evaluate radiation exposure and surgical outcomes after the Tauber procedure. We retrospectively analysed data from 251 patients. Dose area product (DAP) and fluoroscopy time were recorded. The effective dose was calculated with the PCXMC software. Descriptive statistics and linear regression tested the association between clinical predictors and radiation exposure. Median (IQR) age and body mass index (BMI) were 14 (13-16) years and 20.1 (17.9-21.6) kg/m². Five (2.1%) patients developed clinical recurrence and two (0.81%) developed complications. Median fluoroscopy time and DAP were 38.5 (27.7-54.0) s and 89.6 (62.5-143.9) cGy*cm2. The effective dose was 0.19 (0.14-0.31) mSv. Fluoroscopy time was higher in patients with collateral veins (41 (26-49) s vs. 36 (31-61) s, p = 0.02). The median amount of sclerosing agent (SA) used was 3 (3-4) ml. DAP was higher when SA > 3 mL was used (101.4 (65-183) cGy*cm2 vs. 80.5 (59-119) cGy*cm2; p < 0.01). At univariable linear regression, age, BMI, operative time and SA > 3 mL were associated with higher DAP (all p < 0.01). At multivariable linear regression, only BMI (beta 12.9, p < 0.001) and operative time (beta 1.9, p < 0.01) emerged as predictors of higher DAP, after accounting for age and SA > 3 mL. The Tauber procedure is safe and associated with low effective doses. Operative time and the patient's BMI independently predict a higher radiation dose.

Editorial Comment.

No AccessJournal of UrologyPediatric Urology1 Mar 2023Editorial CommentThis article comments on the following:Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery vs Scrotal Antegrade Sclerotherapy in Adolescent Varicocele Karen Doersch and David Diamond Karen DoerschKaren Doersch Department of Urology, University of Rochester Medical Center, Rochester, New York More articles by this author and David DiamondDavid Diamond * E-mail Address: [email protected] Golisano Children’s Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003087.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 209(3), pp. 609–610

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.

Surgical outcomes and radiation exposure after antegrade sclerotherapy in the paediatric population: a single center experience

Surgical outcomes and radiation exposure after antegrade sclerotherapy in the paediatric population: a single center experience

Functional outcomes of surgical treatment of varicocele in infertile men: Comparison of three techniques

IntroductionAmong identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate. ObjectiveThe goal of this study was to compare different surgical techniques in terms of morbidity and fertility results. Patients and methodsIt is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques. ResultsPost-operative complication rates were comparable (p = 0,94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0,29 for the sperm concentration and p = 0,49 for the progressive mobility). Spontaneous pregnancy was better (p = 0,03) for patients who have had a varicocelectomy in a sub-inguinal way. ConclusionAll of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better.

Impact of bilateral varicocelectomy in infertile men

Although the progress in diagnosis methods revealed a high incidence of infra-clinical varicocele, the clinical signification of this pathology is controversial. We compared left unilateral varicocelectomy to bilateral surgery in patients with left clinical varicocele associated to an infra-clinical right one. It is a retrospective study conducted between January 2007 and December 2015 concerning men followed for a varicocele related infertility (one-year or more primary infertility) with two altered sperm analysis (oligospermia and/or asthenospermia) and had a left clinical varicocele associated to right infra-clinical one detected at Doppler Ultrasound. Surgical techniques used were open surgery (sub-inguinal way), antegrade sclerotherapy and coelioscopy. All patients were reviewed with a 6 month post operatively spermogram and minimum follow up of 1 year. Our study included 95 men. Thirty-five patients have had a unilateral left surgery (Group I) and 60 patients have had a bilateral surgical treatment (Group II). The pre-operative spermatic parameters (concentration and progressive mobility) were comparable for the 2 groups. After the surgical treatment, an improvement of these parameters was noted in all the patients without significant difference between the two groups regarding sperm concentration (24.07±9.36×106/mL Vs 23.29±3.88×106/mL) and their progressive mobility (30.47±9.04% Vs 32.39±9.54%). The spontaneous pregnancy rate was 22.8% for patients in group I and 26.6% for those in group II without any statistically difference (p=0.68). Treatment of a right s infra-clinical varicocele, when combined with a left clinical varicocele, gave better results in terms of sperm parameters and spontaneous pregnancy than unilateral varicocelectomy but without statistically significant results. 3.

Impact de la sclérothérapie antégrade de varicocèle gauche clinique sur le spermogramme

Study the early postoperative course of sperm parameters after antegrade sclerotherapy (AS) of clinical left varicocele (CLV) in men consulting for infertility with sperm disruption, and to validate the efficacy and safety of treatment. Monocentric retrospective observational study of men with CLV, consultant in medically assisted procreation center for primary or secondary infertility of the couple. All patients were operated by SA via scrotal approach. After clinical and ultrasound checks at 6 weeks, a control spermogram was performed at 3-6 months of surgery. The following parameters were analyzed: sperm count, motility, percent of normal form, and total number of motile sperm ("total motile sperm count" [TMSC]). The study involved 138 men (median age 33 years) with sperm alteration. All patients benefited from AS of their CLV. No Clavian complication > 1 was observed. Postoperative control demonstrated a significant improvement in all spermogram parameters, with a median progression of 40% of the count (55 vs 32×106), 80% of the concentration (20.3 vs 11.1×106/ml), 30% of the motility (34.7% vs 26.5%), 60% of the normal form percentage (4.0 vs 2.5%) and the 75% TMSC (41.5 vs 23%), 7×106) (p<0.005). SA is an effective and safe technique for treating CLV and improving sperm parameters fertility indicators. Our results suggest that this treatment may be recommended to infertile men with CLV in the management of infertility of the couple. 3.

Comparison of scrotal antegrade sclerotherapy and laparoscopic Palomo surgery in treatment of adolescent varicocele: A 15-year review

Varicocele is a common condition seen in adolescence and associated with adult subfertility. Numerous types of intervention have been described with differences in success and complication rates. This study aims to review and compare the surgical outcomes of laparoscopic Palomo surgery and scrotal antegrade sclerotherapy at our center. A retrospective analysis was done of all patients younger than 18 years old with idiopathic varicocele treated operatively between February 2001 and December 2016. Demographics such as age at operation, side, varicocele grade, operative date, and types of operation were collected. Primary outcomes were clinical recurrence, defined as any grading noted on follow-up within 1 year post-op and post-operative hydrocele. Secondary outcomes were operative time, length of stay, and other surgical complications. Mann-Whitney U test, independent t test and chi-square tests were used for analysis. All p-values were two-sided and considered statistically significant at p≤0.05. A total of 119 patients fit the criteria, of whom 117 patients were included in data analysis (Table). Sixty-two patients had laparoscopic Palomo surgery (LPS) and 55 had scrotal antegrade sclerotherapy (SAS). Clinical recurrence (grade 2-3) within 1 year was similar between the two groups, with four out of 48 patients in the SAS group and six out of 62 patients in the LPS group (8.4% in SAS vs. 9.7% in LPS, p=1.00). Of the 11 patients who had recurrence in the SAS group, seven had grade 1 recurrence (14.5%), two (4.2%) had grade 2 recurrence, and two (4.2%) had grade 3 recurrence. For the LPS group, 17 out of 62 patients had clinical recurrence within 1 year, of whom 11 (17.7%) had grade 1 recurrence, one (1.6%) had grade 2, and five (8.1%) had grade 3 recurrence. Post-operative hydrocele was significantly higher in the LPS group; there was none in the SAS group but 11 patients in the LPS group (0% in SAS vs. 17.7%, p=0.002). Three patients had clinically significant hydrocele requiring Jaboulays' procedure. Complications other than hydrocele were noted in three patients in the SAS group and one patient in the LPS group (5.5% in SAS vs. 1.6% in LPS, p=0.158). None required operative intervention. No conversion to open procedure was seen in the LPS group and there were no perioperative complications. Mean operative time was 62.9minin the SAS group and 60.7minin the LPS group (p=0.624). Mean length of stay was 17.5h in the SAS group and 31.7h in the LPS group (p<0.001). Both SAS and LPS are safe procedures for treatment of adolescent varicocele with similar clinical recurrence rate within 1 year. SAS has a significantly lower rate of post-operative hydrocele.

Antegrade sclerotherapy in adolescent varicocele patients

In the 1970s, Tauber described the antegrade sclerotherapy technique to treat varicoceles, and reported a 10% recurrence rate. The present study aimed to evaluate paediatric success rates and the effect of modifications to the surgical technique. A prospective study was performed of all adolescent patients undergoing antegrade sclerotherapy surgery. Each patient had an idiopathic varicocele with spontaneous venous reflux on Doppler examination, and underwent cannulation of a pampiniform plexus vein via a scrotal incision under general anaesthetic. Aethoxysklerol® 3% (2ml/kg) maximum 3ml was injected into the pampiniform plexus vein under fluoroscopic monitoring. Success was assessed by clinical examination and Doppler ultrasound 3, 6 and 9 months after surgery. Data were presented as median (interquartile range). Patients were split into three groups: Group A - liquid sclerotherapy with Y connector; Group B - liquid sclerotherapy direct to cannula; and Group C - foam sclerotherapy direct to cannula. Fisher's exact test was used to compare the success rates in each group. A total of 91 patients underwent antegrade sclerotherapy. The median age was 14.8 years (range 13.7-15.5). Eleven persistent varicoceles occurred and were diagnosed by Doppler ultrasound. The success rate of surgery was 58% in Group A, 90% in Group B and 96% in Group C. Success was significantly higher in Group B and Group C compared with Group A. No testicular atrophy occurred; two wound infections, two haematomas and one hydrocele were recorded (Table). Introduction of antegrade sclerotherapy in the adolescent population resulted in a safe and cost-effective method for the management of adolescent varicocele. Several modifications to the technique have been introduced to achieve a high success rate (96%) with minimal complications.

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

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.

Why open surgery for treatment of paediatric varicocele?

The high surgical ligature of spermatic vessels modified Palomo and the antegrade sclerotherapy according to Tauber represent two therapeutic modalities at last assured. In the experience of the Author the surgical technique is better with regard to the appearance of relapsing varicocele and the mean operative time.

Scrotal antegradesclerotherapy demonstrates anatomical variations on venous drainage in paediatric, adolescent and young adult varicoceles

Anatomical variations on venous drainage in varicoceles are under-reported. We report our experience in scrotal antegrade sclerotherapy (SAS) for adolescent varicoceles. Since 2011, 15 consecutive boys with left varicoceles were recruited. Under general anaesthesia, a 5-mm transverse incision was made at scrotal neck, testicular vein was cannulated at pampiniform plexus with venogram performed. Foam sclerosant by mixing sodium tetradecyl sulphate (STS), Lipiodol(®) and air was slowly injected under fluoroscopy. Postoperatively the patients were followed-up for varicocele grading, testicular size, and complications. Median age at operation was 14 (10-19) years. 80 % had grade three varicoceles, 33.3 % had smaller left testis before operation. Intra-operative venogram showed three different anatomical variations. Group I: eleven patients (73.3 %) had single distinct internal spermatic vein; Group II: two patients demonstrated duplication of internal spermatic vein draining into left renal vein; Group III: two patients had pampiniform plexus draining to iliac and/or paraspinal veins. SAS was performed in Group I and II patients. Sclerosant volume injected ranged from 1.5 to 4.5 ml. In Group III patients, surgical ligation of testicular veins was performed rather than SAS to avoid uncontrolled systemic sclerosant spillage. Mean length of stay was 1.13 day. One patient with scrotal haematoma and one other with minor wound dehiscence were managed conservatively. Mean follow-up period was 10.9 (1-22) months. Thirteen patients (86.7 %) achieved varicocele grading ≤ 1. There was no postoperative testicular atrophy, hydrocele and epididymo-orchitis. Scrotal antegrade sclerotherapy using STS foam is a safe and effective treatment for adolescent varicoceles. Anatomical variations on venous drainage in varicoceles are common.

Ischemic Necrosis of the Sigmoid Colon after Antegrade Sclerotherapy of Idiopathic Varicocele: A Case Report

A 34-year-old man affected by grade IV idiopathic varicocele with mild testicolar pain, severe oligoasthenozoospermia and infertility, underwent an antegrade sclerotherapy according to Tauber surgical technique. After 5 days, the patient underwent a laparoscopic left colon resection with colonstomy due to a segmental infarction of the sigmoid colon.

Pubertal Screening and Treatment for Varicocele do not Improve Chance of Paternity as Adult

We investigated the eventual positive effects of early screening and treatment for varicocele in pubertal boys without symptoms to determine their chance of paternity later in life. It has not been proved if the presence of varicocele during puberty has an influence on later fertility or paternity. However, since an influence is believed to exist, beginning in 1987 the Belgian Society of Pediatrics has recommended screening all boys 12 to 17 years old during their yearly medical examination and referral for followup or treatment if varicocele is detected. At our clinic patients and their parents were informed about and able to choose between varicocele treatment (antegrade sclerotherapy) and observation. We subsequently contacted these patients, who are now older than 30 years, and inquired about their paternity. We selected for this study pubertal boys 12 to 17 years old with a varicocele who were referred by screening pediatricians to our pediatric urology clinic between 1989 and 2005. We excluded patients with bilateral or unilateral right varicocele and patients with other medical problems that could influence fertility. A total of 661 patients were eligible for the study. Minimally invasive treatment of varicocele, ie antegrade sclerotherapy (with the patient under local or general anesthesia), was offered but not required. Of the patients 372 underwent treatment (mean age 15.3 years, median 15.6) and 289 were followed conservatively (mean age 17.1, median 16.4). All patients were contacted twice by letter and, if no response was received, once by telephone. Patients were asked about paternity, time to conception and whether they had visited a fertility center. Of the 361 respondents 158 (43%) had an active desire to have a child. Paternity was achieved in 85% of the conservatively followed group and 78% of the active treatment group (p >0.05). There is no beneficial effect of pubertal screening and treatment for varicocele regarding chance of paternity later in life.

1364 SCREENING AND EARLY TREATMENT FOR VARICOCELE IN PUBERTAL BOYS IS NOT BENEFICIAL FOR THEIR ADULT PATERNITY CHANCE

You have accessJournal of UrologyPediatrics: Andrology - Cryptorchidism & Varicoceles1 Apr 20121364 SCREENING AND EARLY TREATMENT FOR VARICOCELE IN PUBERTAL BOYS IS NOT BENEFICIAL FOR THEIR ADULT PATERNITY CHANCE Guy Bogaert, Christophe Orye, and Gunter Dewin Guy BogaertGuy Bogaert Leuven, Belgium More articles by this author , Christophe OryeChristophe Orye Leuven, Belgium More articles by this author , and Gunter DewinGunter Dewin Leuven, Belgium More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1748AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is non-proven hypothesis that the treatment of a varicocele during puberty would have any influence on fertility or paternity chance. However, since this hypothesis was believed in Belgium in 1987, it was decided to start screening nationwide all schoolboys between 12-17 yrs for a varicocele. In our clinic, the boys and their parents were informed objectively and were able to choose between treatment or follow-up of testicular growth. As most of these schoolboys are adults now, it was time to investigate and ask for their paternity. METHODS 661 patients (<17yr) visited between 1987 and 2005 our pediatric urology clinic for a “simple” varicocele (excluded: bilateral, right-sided, cryptorchidism or other medical problems). Antegrade sclerotherapy (under local or general anesthesia) was offered but not imposed. 372/661 underwent treatment (mean-age=15yr; median-age=15yr) and 289/661 were followed conservatively (mean-age=17yr; median-age=16yr). All patients were recently contacted (intensive attempts of communication using letter, telephone ande-mail) and asked for paternity, time to conception and eventual fertility assisted treatment. RESULTS 361/661 patients responded. The response rate to the survey is comparable in both groups (median-age=31yr in the treated group, median-age=32yr in the follow-up group). 157/361 had an active child wish (72/148 in the control group and 86/201 in the treatment group). Effective paternity was 91% in the conservative group and 86% in the treatment group (p > 0.05). CONCLUSIONS This study has shown that there is no beneficial effect for schoolboys screening and treatment for varicocele in regards for later paternity chance. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e553-e554 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guy Bogaert Leuven, Belgium More articles by this author Christophe Orye Leuven, Belgium More articles by this author Gunter Dewin Leuven, Belgium More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Interventional Radiology of Male Varicocele: Current Status

Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.

Surgical Subinguinal Approach to Varicocele Combined With Antegrade Intraoperative Sclerosis of Venous Vessels

Varicocele is treated by different surgical techniques, none of which is yet acknowledged as the "gold standard." Some of these techniques, especially microsurgical techniques, are very time consuming and thus expensive, and the treatment of varicocele still causes some complications and recurrences. Marmar and Kim's technique presents some indisputable advantages: it allows the preservation of the arteries and seems to offer the highest percentage of success and lowest number of complications. The authors modified and simplified the microsurgical technique of Marmar and Kim, using a subinguinal approach with intraoperative antegrade sclerotherapy of dilated veins. After the cord has been clamped, 1.5 to 3 mL of 3% aetoxisclerol mixed with 0.5 mL of air is injected. Commonly, minor complications can occur. The most common complication is transient penile lymphangitis, the cause of which is unclear. As the procedure allows selective sparing of the lymphatic vessels, it avoids hydrocele due to the performed procedure.

The role of varicocele sclerotherapy in men with severe oligo-astheno-teratozoospermia

The aim of this study was to verify the role of antegrade scrotal sclerotherapy for the treatment of varicoceles in infertile men with severe oligo-astheno-teratozoospermia (OAT). The 59 patients with severe OAT in this study underwent antegrade scrotal sclerotherapy for the treatment of varicoceles. The outcome was assessed in terms of improvement in semen parameters and spontaneous conception rate. Semen parameters and reproductive hormones were evaluated before antegrade sclerotherapy (AS) and 6 months after AS. After an average follow-up time of 34.8±3.2 months, significant improvement was noted in the mean sperm concentration, motility and morphology in 36 patients (61%). Spontaneous pregnancy occurred in nine couples (15%). Six months after treatment, inhibin B levels were significantly higher (P<0.04), whereas follicle-stimulating hormone (FSH) levels were significantly lower (P<0.001) than before treatment. Antegrade internal spermatic vein sclerotherapy can significantly improve seminal parameters and hormonal parameters in men with severe OAT and may even result in spontaneous pregnancy in couples who would otherwise be candidates for intracytoplasmic sperm injection (ICSI).

Comparison of Inguinal Approach, Scrotal Sclerotherapy and Subinguinal Antegrade Sclerotherapy in Varicocele Treatment: A Randomized Prospective Study

We compared outcome and complications of three simple varicocelectomy techniques. Groups were divided according to whether they would receive the Ivanissevich technique (n = 55), Tauber’s technique (n = 51) or subinguinal sclerotherapy (n = 49). Selection criteria were: infertility >1 year, subnormal semen, sonographic diameter of veins >3 mm and time of regurge >2 s. Patients were randomly assigned to the groups of treatment, with follow-up every 3 months for 1 year. Improvement was only in sperm count and total motility for all groups. Pregnancy rates were 20, 13.73 and 12.24%, respectively, with no significant difference between groups. Hydrocele occurred only in the group which received the Ivanissevich technique (5.5%). Tauber’s technique is simple; however, it has the disadvantage of multiple branching of small veins.