Antegrade Sclerotherapy Research Articles

Antegrade Scrotal Sclerotherapy for Treating Primary Varicocele in Children - Single Center Experience

Purpose To evaluate the effectiveness of antegrade sclerotherapy (AS) for the treatment of primary varicocele in children. Material and Methods Retrospective study of the charts of 30 boys who underwent AS between 7/2005 and 6/2009 at our institution. Indication for treatment was grade II and III varicocele (Tauber classification), confirmed by clinical and ultrasound (US) examination. Three per cent ethoxy sclerol was the sclerosing agent. Follow up included clinical examination and Doppler US 3 months after the procedure and then yearly for at least 2 years. Results 30 boys (mean age 14 years, range 12 – 17 years) with 31 primary varicoceles underwent AS as an outpatient procedure. In 28 boys, varicocele was on the left side, and one patient each demonstrated bilateral and right sided varicocele, respectively. Varicocele was grade II in 13 patients and grade III in 17 patients. Follow-up including Doppler US was 26 months (range 4-51 months). AS was successful in 28 patients resp. 29 varicoceles (93.5%). 2 patients had a persistent varicocele, and they had repeat AS successfully (no recurrence at follow-up). There were complications after surgery in 2 (6.6%) patients (1 superficial wound infection, 1 scrotal haematoma). No hydrocele and no testicular necrosis was observed. Conclusions AS is an efficient minimally invasive surgical procedure for the treatment of varicocele in adolescent boys. Surgery may be performed as an outpatient procedure. During a follow-up of more than 2 years, we observed no serious side effects. To evaluate the effectiveness of antegrade sclerotherapy (AS) for the treatment of primary varicocele in children. Retrospective study of the charts of 30 boys who underwent AS between 7/2005 and 6/2009 at our institution. Indication for treatment was grade II and III varicocele (Tauber classification), confirmed by clinical and ultrasound (US) examination. Three per cent ethoxy sclerol was the sclerosing agent. Follow up included clinical examination and Doppler US 3 months after the procedure and then yearly for at least 2 years. 30 boys (mean age 14 years, range 12 – 17 years) with 31 primary varicoceles underwent AS as an outpatient procedure. In 28 boys, varicocele was on the left side, and one patient each demonstrated bilateral and right sided varicocele, respectively. Varicocele was grade II in 13 patients and grade III in 17 patients. Follow-up including Doppler US was 26 months (range 4-51 months). AS was successful in 28 patients resp. 29 varicoceles (93.5%). 2 patients had a persistent varicocele, and they had repeat AS successfully (no recurrence at follow-up). There were complications after surgery in 2 (6.6%) patients (1 superficial wound infection, 1 scrotal haematoma). No hydrocele and no testicular necrosis was observed. AS is an efficient minimally invasive surgical procedure for the treatment of varicocele in adolescent boys. Surgery may be performed as an outpatient procedure. During a follow-up of more than 2 years, we observed no serious side effects.

Efficacy of antegrade scrotal sclerotherapy (ASS) for the treatment of the testicular varicocele

Efficacy of antegrade scrotal sclerotherapy (ASS) for the treatment of the testicular varicocele

Improvement of seminal parameters and pregnancy rates after antegrade sclerotherapy of internal spermatic veins

To evaluate the impact of antegrade scrotal sclerotherapy on seminal parameters and pregnancy rates in varicocele patients who have impairment of seminal parameters and/or couple infertility. Longitudinal, noncomparative study. Tertiary university hospital. Three hundred sixty-four consecutive varicocele patients with seminal impairment, including 173 (47.5%) patients who were not interested in fertility and 191 (52.5%) who were infertile. Modified antegrade scrotal sclerotherapy. Increase in sperm count, motility, and/or normal forms in all patients. Pregnancy rates 12 months after treatment in infertile men. The median patient age was 32 years. Twelve months after treatment, persistent reflux was present in 45 (12.4%) cases. In 188 (51.6%) patients with low sperm number, sperm count statistically significantly improved, from 12 to 19.5 x 10(6) per milliliter. In the 336 (92.3%) patients with asthenospermia, progressive motile forms statistically significantly improved, from 25% to 45%. In the 147 (40.4%) patients with teratospermia, normal forms increased from 17% to 35%. In infertile patients without persistent varicocele, 65 (37.4%) patients fathered offspring. Patients obtaining a pregnancy presented a significantly higher sperm motility than did infertile patients (46% vs. 35%). Antegrade scrotal sclerotherapy significantly improves sperm count, motility, and morphology. Patients with couple infertility achieved a pregnancy in 37% of cases. Patients achieving pregnancy present a better progressive motility after treatment than patients who did not father any child.

Surgical Outcomes After Modified Antegrade Scrotal Sclerotherapy: A Prospective Analysis of 700 Consecutive Patients With Idiopathic Varicocele

We analyzed the surgical outcomes of antegrade scrotal sclerotherapy in a large, prospective, multisurgeon, consecutive series of patients treated for idiopathic varicocele. We prospectively collected data on 697 consecutive patients undergoing antegrade scrotal sclerotherapy between 1997 and 2005. For every patient we evaluated age, side, clinical and Doppler ultrasound grade, and seminal impairment. Perioperative complications were evaluated 1 month after surgery. At 12 months after antegrade scrotal sclerotherapy all patients underwent Doppler ultrasound. In those with seminal impairment semen analysis was also performed. Failure was defined as at least Doppler grade 1 varicocele. Median age of the 697 analyzed patients was 28 years. Mean surgical time was 15 minutes. All surgeries were performed using local anesthesia and no intraoperative complications were observed. All patients were discharged home within 4 hours. Postoperatively complications developed in 35 patients (5%) and failure occurred in 63 (9%). Persistent reflux was observed in 6.5% of adolescents, in 9.4% of adults and in 7.5% of patients with recurrent varicocele. Failure rates were similar for different grades and sides. The failure rate was significantly higher in patients treated by surgeons during the learning curve (p = 0.007). In the 414 patients with seminal impairment median sperm count and the median percent of progressive motility and normal forms significantly improved after surgery (p <0.001). Considering the low persistence and complication rates in all patient categories (adolescents, adults, first diagnosis, and bilateral and recurrent disease) antegrade scrotal sclerotherapy can be proposed as a safe and efficacious first choice treatment for varicocele. A specific learning curve is required to achieve the best outcome.

Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures

This study investigated whether the therapeutic efficacy and morbidity of three minimally invasive techniques for varicocele correction--laparoscopic varicocelectomy (LV), antegrade sclerotherapy (AS), and retrograde embolization (RE)--differed between children and adults. During a 10-year period, 356 procedures for varicocele correction, including 122 cases of LV, 108 cases of AS, and 126 cases of RE, were performed for 314 patients at our institution. Of these patients, 223 were 19 years of age or younger (group 1), and 133 were older than 19 years (group 2). Diagnosis and postoperative results were established clinically and with the use of Doppler ultrasonography. The failure rates and complications for each procedure were retrospectively evaluated and compared between the two age groups. The median follow-up period was 69 months (range, 6-122 months). For 25 patients (19.8%), RE was not feasible for technical reasons. In both groups, LV had a lower failure rate than AS or RE, but the difference between LV and AS was not significant in group 1 (7.7(% vs 11.9%; p > 0.5). Also in group 1, AS was associated with fewer complications than LV 1 (4.5% vs 15.4%; p < 0.05). In group 2, LV was significantly more effective in correcting varicoceles than the other two techniques (p < 0.01). In this group, the complication rates for all three procedures did not differ significantly (p > 0.05). In our experience, LV was more effective than AS or RE in correcting varicoceles. For children and adolescents, AS may be more indicated because of the slightly lower complication rate and similar recurrence rates, as compared with LV, for this age group. The higher incidence of postoperative hydrocele formation after LV warrants more refined techniques such as the lymphatic-sparing approach.

A new technique for the treatment of varicocele combining a subinguinal approach with antegrade sclerotherapy

A new technique for the treatment of varicocele combining a subinguinal approach with antegrade sclerotherapy

Antegrade scrotal sclerotherapy for treating primary varicocele in children

To evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood. From December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9-18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left-sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow-up of 11 (3-60) months, and the operative duration, X-ray exposure time, persistence rate of varicoceles and complications were compared with those using other techniques. In 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume (<75% testicular volume vs the normal side) confirmed by US. The mean (sem) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty-four (97%) patients were eligible for follow-up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow-up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis). AS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication.

Induktion der Spermiogenese nach antegrader Varikozelensklerosierung bei Patienten mit nicht-obstruktiver Azoospermie

The aim of this study was to prove the efficacy of antegrade sclerotherapy for varicocele testis in patients with azoospermia and in patients with cryptozoospermia (less than 0.1 million spermatozoons/mL ejaculate). We have investigated the induction of spermatogenesis in patients with non-obstructive azoospermia after antegrade sclerotherapy. 20 consecutive patients who had been trying to beget a child over a period of one year or longer were chosen for this study. All patients suffered from non-obstructive azoospermia or from cryptozoospermia. We produced a control spermiogram for each patient before, 3 and 6 months after antegrade sclerotherapy. The postoperative spermiogram was done according to WHO criteria and was then compared to the preoperative data. 15 patients (75 %) were found to suffer from azoospermia preoperatively and 5 patients (25 %) from cryptozoospermia. Out of the 15 patients with initial azoospermia 8 (53 %) showed cryptozoospermia (OAT/OT syndrome) after antegrade sclerotherapy. Out of the 5 patients with the initial cryptozoospermia 3 (60 %) showed an improvement in the sperm count and motility criteria. Antegrade sclerotherapy for varicocele testis is a valid treatment option to isolate the spermatozoons from the ejaculate for extracorporeal fertilisation in patients with non-obstructive azoospermia. Complete normalisation of the spermiogram parameters, i.e., sufficient for natural child conception, cannot safely be achieved by this method.

Laparoscopic Surgery versus Antegrade Scrotal Sclerotherapy: Retrospective Comparison of Two Different Approaches for Varicocele Treatment

ObjectiveBoth laparoscopic surgery and antegrade sclerotherapy are effective treatment options in the management of varicoceles. However, very limited data comparing these two approaches are available in the literature. We present our experience regarding outcome and complications with each treatment modality. Patients and MethodsDuring a 10-year period, 122 cases of laparoscopic varicocelectomy (LV) and 108 cases of antegrade sclerotherapy (AS) were performed in our institution. Diagnosis and postoperative results were established clinically and using Doppler ultrasonography. Data regarding failure rate, complications, operative time and length of hospital stay of each procedure were retrospectively evaluated. ResultsMedian follow-up was 59 months (5–130). Failure rates for LV and AS were 4.9% and 15.7%, respectively (p<0.01). Complications occurred in 13.1% after LV, including 13 cases (10.7%) of hydrocele formation, and 4.6% after AS. Hydroceles following LV were significantly more frequent in patients with compared to patients without previous inguinal surgery (27.8% vs. 8.5%; p<0.05). There was no significant difference between LV and AS regarding operative time (36 vs. 34min, p>0.05) and hospital stay (2.2 vs. 2.1 days, p>0.5). ConclusionsIn our experience, LV was more effective than AS in correcting varicoceles. Complications other than hydroceles were higher after AS. The higher incidence of postoperative hydrocele formation following LV warrants strategies such as the lymphatic sparing approach, especially in patients with previous inguinal surgery.

Open surgery versus Tauber antegrade sclerotherapy for treatment of varicocele

Open surgery versus Tauber antegrade sclerotherapy for treatment of varicocele

Treatment of Varicocele: Randomized Prospective Study on Open Surgery Versus Tauber Antegrade Sclerotherapy

The goal of this randomized prospective study in patients with varicocele was to evaluate the outcome following open surgery with inguinal approach versus antegrade sclerotherapy according to the Tauber procedure. From January 2002 to November 2003, we recruited 64 patients with left varicocele for this study. All patients were clinically examined, before surgery and again 8 months postsurgery, by objective examination, scrotal color Doppler ultrasound, and semen analysis. These patients were randomized in a balanced 4-block pattern: depending on randomization, the patients underwent open surgery (group A: 32 patients) or antegrade sclerotherapy according to the Tauber procedure (group B: 32 patients). At the current follow-up, it is possible to evaluate all the patients for whom we have preoperative and postoperative Doppler imaging and semen analysis. An analysis of seminal parameters shows a statistically significant improvement of the rate of fast progressive spermatozoa (P < .05) and reduction in immotile spermatozoa (P < .01) in those patients who underwent sclerotherapy compared to the patients who underwent open surgery. The outcomes of all other parameters (number and morphology) are fully comparable. Operating time is decidedly shorter for antegrade sclerotherapy (P < .01), but there are no significant differences in terms of early or late postoperative complications. It is widely known that varicocele is a condition found in 9% to 23% of the male population around the world; this percentage rises to 40% among infertile males. The treatment of this condition not only resolves clinical symptoms but also stops continuous damage to spermatogenesis, thereby potentially improving fertility. Our experience demonstrates that sclerotherapy (Tauber procedure) combines shorter surgical time and faster recovery of normal daily activities with significant improvement in sperm motility.

Antegrade sclerotherapy for varicocele testis--possible and avoidable complications

Antegrade sclerotherapy is an established procedure for the treatment of varicocele. To avoid complications during the dissection of the pampiniform plexus, detailed knowledge of the angioarchitecture of the spermatic cord is recommended. One group of plexus veins is situated ventrolaterally and is surrounded by a yellowish fat which serves as a landmark. This vein group should be chosen for preparation. Phlebography of the internal testicular vein is mandatory. If arteries or major pelvic veins become visible while applying contrast media, sclerotherapy should not be performed. Paravasation of sclerosing agent has to be recognized and treated immediately to prevent deleterious effects.

Adolescent varicocele: Treatment by antegrade sclerotherapy

Background/Purpose: The most effective treatment for adolescent varicocele is still debated, although the same treatment methods used for adults have also been used in children. Since 1991 at the Pediatric Surgery Operative Unit of “S. Camillo” Hospital in Rome a multidisciplinary protocol has been established according to which percutaneous retrograde scleroembolization was suggested as the first therapeutic option. Surgery (retroperitoneal ligation) was reserved for select cases. The author now presents his personal experience with alternative-approach antegrade sclerotherapy. Methods: Since February 1998, as an alternative to percutaneous retrograde sclerosis and surgical ligation, antegrade sclerotherapy has been performed in 92 varicocele patients, 65 of whom were 11 to 19 years of age. In this group, the indication for treatment was grade III varicocele with spontaneous continual reflux, which worsened with the Valsalva maneuver. Twenty patients had recurrent varicocele after other treatments. Results: At a mean follow-up of 9 months, the clinical recovery rate was 92.6%. Conclusions: Antegrade sclerotherapy is an intermediate treatment because of its invasive nature and success rate compared with more commonly used percutaneous retrograde sclerosis and Palomo procedures in adolescents. In particular, this method is highly effective and well-accepted by patients with recurrent varicocele. J Pediatr Surg 36:1546-1550. Copyright © 2001 by W.B. Saunders Company.

ADOLESCENT VARICOCELE: TAUBER ANTEGRADE SCLEROTHERAPY VERSUS PALOMO REPAIR

There is general agreement on treatment for varicocele in pediatric patients. Randomized prospective studies have shown that anatomical and functional lesions may be corrected. Due to the impossibility of seminal examination patients with moderate to large varicocele or ipsilateral testicular hypertrophy, characterized by a change in testicular consistency or symptoms, should undergo surgical correction. The best therapeutic approach is still under discussion. At 2 centers 2 therapeutic approaches to varicocele treatment in pediatric patients were compared, namely the Palomo repair and antegrade sclerotherapy according to Tauber. The 89 patients from the same geographical area elected 1 procedure after an explanation. From the medical records we retrospectively evaluated operative time, postoperative analgesics, postoperative fever onset, complications, convalescence, recurrence and postoperative hydrocele. After Palomo repair in 45 patients there were 2 recurrences (4.4%) and 2 postoperative hydroceles (4.4%). Of 44 antegrade sclerotherapy cases 1 was converted to Palomo repair, there was no hydrocele formation and recurrence developed in 2 (4.5%). Testicular atrophy was not observed in any patient regardless of the method used. The cost of the procedure was lower in the sclerotherapy group. These data suggest that the failure rate was similar in both groups. The principal advantages of sclerotherapy are simplicity, decreased cost and lack of hydrocele formation.

Simultaneous Microsurgical Spermatic Vein Ligation and Sclerotherapy

Objectives: Microsurgical ligation as well as antegrade sclerotherapy have been established in varicocele treatment. The aim of this study was to evaluate whether a combination of microsurgery and sclerotherapy can provide a safe and effective treatment of varicocele recurrence or persistence. Methods: Nine patients with recurrent or persistent varicoceles were operated by means of the combination method. Under microscopic control varix veins were ligated selectively preserving lymphatics and arteries. Ectopic veins as a possible source for varicocele persistence or recurrence were also ligated. Finally, an intraoperative venography with subsequent sclerotherapy was performed through one of the dissected veins. Results: Despite difficult anatomical situations after previous surgical interventions, the operations were performed successfully without any complications. Clinical controls showed varicocele disappearance without damage of the testis. No varicocele recurrence or persistence was observed. Conclusions: This method combines the advantages of both methods. Precision of the microsurgical technique is combined with velocity of sclerotherapy. Thus, it may represent an interesting alternative to conventional operation methods especially in the treatment of recurrent or persistent varicoceles.

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

COMPARATIVE ASSESSMENT OF PEDIATRIC TESTICULAR VOLUME: ORCHIDOMETER VERSUS ULTRASOUND

Treatment of varicoceles in childhood and adolescence with Tauber's antegrade scrotal sclerotherapy

Purpose: The aim of this study was to evaluate surgical complications and the outcome of grade II and III varicoceles treated with Tauber's antegrade scrotal sclerotherapy. Methods: A total of 21 patients with a median age of 13 (range, 10 to 21) years and left-sided grade II and III varicoceles were treated with Tauber's antegrade scrotal sclerotherapy and underwent follow-up over a median period of 23 months (range, 9 to 35). Results: One grade II varicocele persisted after antegrade sclerotherapy for 6 months. After a second sclerotherapy 6 months later, no further recurrence was detected. One patient with a grade II to III varicocele had a grade I varicocele recurrence 14 months after operation. Three patients showed a slight hydrocele postoperatively. Conclusion: This limited series indicates that Tauber's antegrade scrotal sclerotherapy is a safe and effective treatment for grade II and III varicoceles in children and adolescents. J Pediatr Surg 35:1222-1225. Copyright © 2000 by W.B. Saunders Company.

P-011. A simplified technique of antegrade sclerotherapy for infertile men with varicocele

P-011. A simplified technique of antegrade sclerotherapy for infertile men with varicocele

Morphological and functional aspects of the human spermatic cord veins.

It is well known that varicocele of the testis may lead to a damage of testicular tissue and therefore is one etiologic factor for male infertility. Successful varicocele treatment may result in preserving or restoring fertility. Antegrade sclerotherapy has proved to be safe, economical and effective (Bruns et al., 1996). The major component of this procedure is the preparation of the pampiniform plexus. After insertion of a canula into a selected vein of the plexus and fluoroscopic control showing drainage by the internal spermatic vein, a sclerosing agent (AthoxysklerolR) is injected in an antegrade direction. By analysis of the vascular organization of the pampiniform plexus (Ergun et al., 1994) it could be demonstrated that the testicular veins are organized in two main groups and form two vein plexus. One of these vein groups forms a tight plexus around the testicular artery, the other vein group is embedded in a large macroscopically visible section of fatty tissue. To save the testicular artery from injury during dissection, the vein group in this lateroventral compartment should be dissected for antegrade sclerotherapy.

La nostra esperienza nella correzione del varicocele mediante sclerotizzazione anterograda: Risultati e analisi dei costi

The antegrade sclerotherapy of spermatic veins suggested by R. Tauber in 1988 is one of the most interesting methods for treating varicocele. This technique consists of isolating and cannulating a dilated spermatic vein and then injecting a sclerosing mixture. The procedure is carried out under local anaesthesia and through a small scrotal incision. Antegrade sclerotheraphy is relatively cheap, easy and quick to perform and seems as reliable as surgical ligation and section of the spermatic veins, which is why, in our opinion, antegrade sclerotherapy plays an important role in treating varicocele. This paper describes our preliminary results.