Antegrade Scrotal Sclerotherapy Research Articles

Varicoceles: Overview of Treatment from a Radiologic and Surgical Perspective.

A testicular varicocele is the result of the expansion of the venous pampiniform plexus of the scrotum. Often painless, a significant number of patients experience orchialgia, swelling, testicular atrophy, and abnormalities in spermatic parameters. Treatment of symptomatic varicocele involves a radiologic or surgical intervention to obstruct the reflux of venous drainage. Testicular anatomy, diagnostic evaluation and imaging, options for surgical intervention, and a step-by-step description of retrograde embolization and antegrade scrotal sclerotherapy are discussed. Furthermore, included is an overview of postprocedural management and patient outcomes for radiological interventions, and the most up-to-date evidence on the efficacy of varicocele treatments as well as how they compare to each other.

Antegrade Scrotal Sclerotherapy of Internal Spermatic Veins for Varicocele Treatment: Results and Complications about 660 Cases

Introduction: Varicocele is one of the leading causes of male infertility. Anterograde scrotal sclerotherapy (ASS) is one of the most recent techniques. Our objective is to evaluate the results of ASS in the treatment of varicocele in adults. Methods: This is a descriptive and analytical study of 660 patients treated for varicocele causing either a picture of hypofertility and/or symptomatic during the period from January 2008 to December 2018. Preoperative, intraoperative and postoperative data were analysed. Results: The average age was 30. The average duration of the intervention was 16 minutes (13-50 mins) and the average length of hospitalization was 19 hours (9-36 hours). We noticed a statistically significant improvement in all characteristics on the postoperative spermogram. Oligospermia increased from 41% to 29% (p=0.01), asthenospermia increased from 52% to 33% (p=0.02) and teretospermia from 24% to 14% (p=0.006). The paternity rate among hypofertile men was 22%. The disappearance of varicocele in postoperative was objectified in 588 patients (84%), the disappearance of scrotal pain in 322 patients (48%). Complications were identified in 70 patients (10.6%) hydrocele (27 patients, 4%), scrotal hematoma (14 patients), chemical orchitis (20 patients) and testicular atrophy (9 patients). A recurrence was noted in 73 patients (11%) at 9 months. Conclusion: SSA appears to be a reliable and reproducible technique in the treatment of varicocele, with significantly less morbidity in comparison with other techniques. We recommend it as a first-line treatment.

Antegrade scrotal sclerotherapy of internal spermatic veins for varicocele treatment: technique, complications, and results.

Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate. Antegrade scrotal sclerotherapy (ASS) represented one of the main alternatives to the traditional inguinal or suprainguinal surgical ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an original modified technique with a long follow-up. Between December 1997 and December 2014, we performed 674 ASS. Mean operative time was 14 min (range 9 to 50 min). No significant intraoperative complications were reported. Within 90 days from the procedure, postoperative complications were recorded in overall 49 (7.2%) patients. No major complications were recorded. A persistent/recurrent varicocele was detected in 40 (5.9%) cases. In 32/40 (80%) cases, patients showed preoperative grade III varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 × 106 to 21 × 106 ml−1 (P < 0.001). The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% (P < 0.001). Percentage of normal forms increased from 17% before surgery to 35% 1 year after the procedure (P < 0.001). In the subgroup of the 168 infertile patients, 52 (31%) fathered offspring at a 12-month-minimum follow-up. Therefore, ASS is an effective minimal invasive treatment for varicocele with low recurrence/persistence rate.

Large bowel infarct following antegrade scrotal sclerotherapy for varicocele: A case report.

Varicocele is the main cause of male infertility. Treatment stops continuous damage to spermatogenesis, thereby potentially improving fertility. Among all the available procedures, the ante-grade scrotal sclerotherapy (ASS), a combined radiological-surgical approach first introduced by Tauber, is gaining more popularity due to its minimal invasiveness. We report the case of a 35-year old man who was subjected to a colonic resection after antegrade scrotal sclerotherapy for varicocele. The procedure was necessary due to the embolization of venous anastomosis between the spermatic and mesenteric veins, which were not detectable at the preoperative phlebography.

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).

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.

Antegrade Scrotal Sclerotherapy With and Without Tamoxifen for Treatment of Infertile Men Due to Variocele

Antegrade Scrotal Sclerotherapy With and Without Tamoxifen for Treatment of Infertile Men Due to Variocele

MP-11.12: Antegrade Scrotal Sclerotherapy for the Treatment of Varicocele in Adults: Long Term Results About 178 Controlled Cases

MP-11.12: Antegrade Scrotal Sclerotherapy for the Treatment of Varicocele in Adults: Long Term Results About 178 Controlled Cases

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

Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall

The purpose of this study is to describe the normal structure of spermatic vein wall and the morphological alterations in patients with grades 1-3 varicocele. We dissected and analyzed a 2-3 cm tract of a pampiniform plexus vein of 30 patients undergoing antegrade scrotal sclerotherapy for left varicocele and of 13 consecutive patients undergoing radical orchidectomy for left testis cancer. The histological and morphological examination was performed with hematoxylin-eosin and Azan-Mallory staining through a computer image analysis approach. Vasa vasorum number was evaluated through the anti-CD31 monoclonal antibody. In normal veins, the tunica media had a circular smooth muscle layer, the tunica adventitia a longitudinal one; oblique fibers connected the longitudinal with the circular layer. In grade 1 varicocele, we found an increase in the connective tissue of the adventitia (39 vs. 1%, P < 0.001) and of the tunica media (13 vs. 0.5%, P = 0.001) and a decrease of oblique fibers. In grade 2 varicocele, the adventitia and media showed greater connective tissue (40 and 15%, P < 0.001). In grade 3 varicocele, adventitia and media showed a further increase in connective tissue (52 and 28%, respectively, <0.001). No oblique fibers were found in these veins. Vasa vasorum were decreased in number in patients with grades I and II varicocele, and were absent in patients with grade III varicocele. The wall of pampiniform plexus veins is a complex structure. Varicocele induces a decrease of vasa vasorum number, a fibrotic degeneration of the adventitia and media, and a decrease of the oblique running fibers.

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.

POS-01.68: Antegrade scrotal sclerotherapy for the treatment of varicocele: prospective study of 180 cases

Many surgical techniques are available for the treatment of varicocele. Recently introduced, antegrade scrotal sclerotherapy is a simple and easy technique. The aim of this study is to evaluate on a prospective manner the tolerability, safety, and global efficacy of this technique and to determine factors associated with failure.

Surgical Atlas Varicocele: antegrade scrotal sclerotherapy

Antegrade scrotal sclerotherapy (ASS) was introduced in 1988 as an alternative for the treatment of the varicocele [1] and has been subsequently used in our clinic in > 6000 adults and children. By contrast with retrograde sclerotherapy this procedure is feasible in almost all patients (99%) [1]. ASS is less invasive than the open surgical and laparoscopic approaches, and therefore provides a faster recovery to normal activity [2,3].

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.

Modified antegrade scrotal sclerotherapy in adolescent patients with varicocele

Background/Purpose The aim of this study is to evaluate the tolerability, safety, and efficacy of a modified antegrade scrotal sclerotherapy in the treatment of varicocele in adolescent patients. Methods From 1998 to 2001, 45 consecutive adolescent patients (average age, 15.26 ± 1.29; range, 13 to 17 years) underwent modified antegrade scrotal sclerotherapy for varicocele at the authors’ department. All patients were evaluated pre- and postoperatively by physical examination and color Doppler ultrasonography of spermatic cords and testis. All treatments were performed under local anaesthesia by a single surgeon. Complication and reflux persistence rates were assessed 6 and 12 months after treatment. Results The mean operating time was 15 minutes. No patient required general anaesthesia during the treatment. No intraoperative complication was recorded, and all patients were discharged within 4 hours. The patients returned to normal school activity within 48 hours. No complication was observed during the follow-up. Six and 12 months after surgery, only 1 patient had a reflux persistence (2.2%). Conclusions Modified antegrade scrotal sclerotherapy was well tolerated in our adolescent patients under local anesthesia. The procedure is simple, rapid, safe, and effective. The possibility to perform this treatment under local anesthesia decreases the hospitalization time and allows the rapid return to school activity in this particular category of patients.

Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study.

To assess the results of our experience in correcting primary varicocele using a modified technique of antegrade scrotal sclerotherapy. From December 1997 to February 2000, 201 patients with primary varicocele underwent antegrade scrotal sclerotherapy. Before treatment all patients were evaluated by a physical examination, colour Doppler ultrasonography of the spermatic cord, and abdominal and scrotal ultrasonography. Sperm samples were analysed only in patients aged > 18 years. The treatment was administered using a special venous catheter system with a Y-adapter. Complications after treatment and the rate of persistence of reflux were assessed 3 and 6 months after the antegrade scrotal treatment, by clinical examination and colour-Doppler ultrasonography of the spermatic cord. The mean operative duration was 15 min; there were no significant complications during treatment and all patients were discharged within 4 h. Complications after treatment occurred in 10 of the 201 patients (5%); four patients had epididymo-orchitis, three a scrotal haematoma, one a surgical wound infection, one persistent scrotal pain and one persistent flank pain on the same side as the surgery. Reflux was persistent in 12 patients (6%). Antegrade scrotal sclerotherapy is a simple, minimally invasive and highly effective technique for blocking spermatic vein reflux, with a low rate of complications. The technical changes simplified the cannulation of the spermatic vein and facilitated antegrade phlebography and sclerotherapy using the air-block technique.

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.

Semen analysis after treatment of varicocele by antegrade scrotal sclerotherapy.

Varicocele is a major cause of male infertility. Different studies have shown that varicocele is associated with a progredient deterioration of testicular function. This fact constitutes the indication for treatment of varicocele, which has been underscored by the results of studies demonstrating that the correction of varicocele can arrest testicular damage and can lead to improved spermiogenesis (Hadziselimovic et al., 1989; Kass & Belman et al., 1987). We have established antegrade scrotal sclerotherapy (ASS) for treatment of varicocele (Tauber & Johnsen, 1994). This study wants to examine the influence of antegrade sclerotherapy of varicocele on spermiogenesis and generative power.

Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence: A.M. Mottrie, Y. Matani, J. Baert, et al. Br J Urol 76:21–24, (July), 1995

Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence: A.M. Mottrie, Y. Matani, J. Baert, et al. Br J Urol 76:21–24, (July), 1995