Varicocele Embolization Research Articles

Antegrade embolization of varicocele with cyanoacrylate glue: a case report

BackgroundVaricocele embolization is an effective, minimally invasive treatment option, with a symptom improvement rate of around 90%. However, anatomical variations and post-embolization recurrences pose challenges to its efficacy. This article discusses the antegrade embolization technique as a viable alternative for cases in which retrograde embolization fails, offering a broader spectrum of treatment options for varicocele.Case presentationThis case report details the treatment of a 27-year-old male with a left varicocele, diagnosed during infertility assessment, using an alternative embolization technique. Despite initial failed attempts at retrograde catheterization via the femoral vein, a direct inguinal puncture of the left testicular vein was successfully performed under ultrasound guidance. A mixture of Glubran® and Lipiodol® was used for embolization, achieving varicocele embolization without complications. The patient was discharged 2 hours post-procedure, with follow-up confirming the procedure’s effectiveness and safety.ConclusionThis article introduces a less invasive, ultrasound-guided technique for varicocele embolization, presenting a viable alternative to surgery when conventional retrograde methods fail.Graphical

Effect of varicocele surgery on sperm quality

Introduction: A varicocele is a vascular lesion characterised by dilatation and tortuosity of the veins of the pampiniform plexus and is found in approximately one-fifth of the adult male population. It is the most common cause of treatable infertility. Physical examination may or may not show a varicocele which is mostly diagnosed only when patients present with infertility or adolescents during a physical examination, like testicular hypotrophy, impairment in spermatogenesis mainly in the form of low or absent count, decreased sperm motility, and abnormal sperm morphology. Treatment for varicocele includes medical therapies, radiological embolization, and surgical techniques. Medical therapy, including antioxidants and anti-inflammatory agents, has been utilized with variable success. Radiological embolization of varicocele is a new technique in the treatment of varicocele, but it is associated with high recurrences and high cost. Varicoceles are surgically treated either by open or laparoscopic approaches the principal aim being occlusion of the dilated veins of the pampiniform plexus. A definitive conclusion of indication of medical treatment cannot be drawn at present because most published studies have inadequate design and lack controls. Various studies in the past have concluded significant changes in sperm parameters (total count, motility, morphology) post-varicocele repair. However, few other studies suggest no improvement in sperm parameters following surgical varicocele repair and studies that conclude recommendations against repair of varicocele. Thus, conflicting opinions have opened the scope to establish this fact by this study. Aim: To evaluate changes in sperm morphology, sperm count, and sperm motility in a patient with varicocele after varicocele surgery. Materials and methods: The study was conducted in the Department of Surgery, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi, India from August 2019 to February 2021. The sample size was calculated to be 50 using Slovin’s formula with a confidence level of 95% with a margin error taken as 5% (p - value 0.05). Sperm morphology, sperm count, and sperm motility were the parameters studied before and after 3 months of surgery. Results: The majority of patients belonged to the age group of 18 to 25 years (42%) followed by 26 to 35 years (40%) (27.78 ± 6.547 years). Left-sided varicocele was more common (54%), followed by bilateral varicocele (42%). Varicocele grade II was most common (58%) followed by grade I (30%) and lastly grade III (12%). Total sperm count improved by 8.88 million per ml after varicocelectomy. Total sperm motility improved by 6.08% after the surgery. Total normal sperm forms improved by 6.44% after varicocele repair. Conclusion: Based on the findings it was concluded that Varicocelectomy results in significant improvement in total sperm count, total sperm motility, and total normal sperm morphology. The best improvement was seen in sperm count followed by total normal sperm forms and lastly total sperm motility.

Large left varicocele in a patient with portal hypertension treated via transjugular intrahepatic portosystemic shunt placement and both variceal and varicocele embolization

BackgroundScrotal swelling from varicocele is a common complaint in adult men. Varicocele due to portosystemic collaterals is a rare presentation of portal hypertension. Imaging workup and intervention for varicocele in this case is more complex than varicocele due to absent or incompetent valves in the testicular veins and pampiniform plexus.Case presentationWe present the case of a 53-year-old man with alcohol-related cirrhosis presented with persistent left scrotal heaviness, pain, and swelling found to have a large left varicocele. Given his history of cirrhosis, a contrast-enhanced CT of the abdomen and pelvis was obtained showing that the varices were supplied by a vessel arising from the splenic vein and draining into the left renal vein as well as gastric varices. Varicocele embolization alone is not sufficient in this case, and we treated with transjugular intrahepatic portosystemic shunt, variceal and varicocele embolization.ConclusionIn patients presenting with a varicocele with a history of cirrhosis/portal hypertension, cross sectional imaging of the abdomen and pelvis should be obtained prior to treatment to evaluate for the presence of varices which may be pressured by varicocele embolization. If present, consideration should be given to referral to an interventional radiologist for possible concurrent variceal embolization and TIPS placement.

MP30-09 ARE COMPLETE AZFc DUPLICATIONS ASSOCIATED WITH SPERMATOGENIC POTENTIAL? THE FIRST REPORTED SERIES

You have accessJournal of UrologyCME1 Apr 2023MP30-09 ARE COMPLETE AZFc DUPLICATIONS ASSOCIATED WITH SPERMATOGENIC POTENTIAL? THE FIRST REPORTED SERIES Kian Asanad, Mary Samplaski, Elena Kolomeitz, Stephen Scherer, Ryan Yuen, Christian Marshall, Kirk Lo, Ethan Grober, Brendan Mullen, Susan Lau, and Keith Jarvi Kian AsanadKian Asanad More articles by this author , Mary SamplaskiMary Samplaski More articles by this author , Elena KolomeitzElena Kolomeitz More articles by this author , Stephen SchererStephen Scherer More articles by this author , Ryan YuenRyan Yuen More articles by this author , Christian MarshallChristian Marshall More articles by this author , Kirk LoKirk Lo More articles by this author , Ethan GroberEthan Grober More articles by this author , Brendan MullenBrendan Mullen More articles by this author , Susan LauSusan Lau More articles by this author , and Keith JarviKeith Jarvi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is well established that complete AZFc microdeletions are a common cause of male factor infertility. With advances in detection methodology, increasing cases of partial AZFc deletion and Yq duplication, especially those involving the AZFc region, have started to emerge. Here, we report the first series of infertile men with complete AZFc duplications. METHODS: Men presenting for a fertility evaluation at a single male infertility specialty clinic from 2012-2014 who had AZFc complete duplications using a targeted microarray in peripheral blood were identified. Demographics, medical, surgical, family and reproductive history, semen and hormonal parameters, as well as response to therapies were characterized. Fischer’s exact test was used to compare the rate of complete AZFc duplications in the infertile population versus fertile controls. RESULTS: We identified five men having complete AZFc duplications, which represented 4.8% (5/104) of men undergoing Y-chromosome microarray testing and 21% of men with men with AZFc abnormalities. The mean age was 33.7 years. There was a significantly higher proportion of AZFc duplications in the infertile population (5/104) vs. the fertile controls (0/148) (p= 0.013). The mean testicular volume was 18 mL. One man had a left grade 2 varicocele. The mean FSH was 5.5 IU/L (range 1-11 IU/L), LH 3.6 IU/L (range 3-4.2 IU/L), and testosterone 14.5 nmol/L (range 12.5-18.3 nmol/L). With respect to semen parameters, one man was persistently azoospermic. The second man alternated between severe oligospermia and rare non-motile sperm. The third man had one semen analysis demonstrating azoospermia and a second demonstrating a total sperm count (TSC) of 4 ×106. The fourth man was persistently oligospermic with TSCs ranging from 3.96-12.6 ×106. The fifth man had severe oligospermia, with a mean TSC of 1.5 ×106; after intervention (varicocele embolization, clomiphene citrate), his TSC rose to 21.7 ×106. He then fathered a spontaneous pregnancy. CONCLUSIONS: This is the first study to report that complete AZFc duplications are common in those infertile men with AZFc abnormalities, representing 21% of the AZFc alterations in this group. Studies only targeting AZFc deletions are underestimating the frequency of AZFc abnormalities in men with spermatogenic failure. They represent a heterogeneous group, having a variable reproductive potential. Cases should be managed on an individual basis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e394 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kian Asanad More articles by this author Mary Samplaski More articles by this author Elena Kolomeitz More articles by this author Stephen Scherer More articles by this author Ryan Yuen More articles by this author Christian Marshall More articles by this author Kirk Lo More articles by this author Ethan Grober More articles by this author Brendan Mullen More articles by this author Susan Lau More articles by this author Keith Jarvi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP30-17 A COMPARATIVE ANALYSIS OF EMBOLIZATION VERSUS SURGICAL MANAGEMENT OF VARICOCELE IN THE PROVINCE OF ONTARIO: A POPULATION-BASED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP30-17 A COMPARATIVE ANALYSIS OF EMBOLIZATION VERSUS SURGICAL MANAGEMENT OF VARICOCELE IN THE PROVINCE OF ONTARIO: A POPULATION-BASED STUDY Aidan Canil, Wenbin Li, Kingston Canada, Premal Patel, Winnipeg Canada, Ben Mussari, Timothy Hanna, D. Robert Siemens, and R. Christopher Doiron Aidan CanilAidan Canil More articles by this author , Wenbin LiWenbin Li More articles by this author , Kingston CanadaKingston Canada More articles by this author , Premal PatelPremal Patel More articles by this author , Winnipeg CanadaWinnipeg Canada More articles by this author , Ben MussariBen Mussari More articles by this author , Timothy HannaTimothy Hanna More articles by this author , D. Robert SiemensD. Robert Siemens More articles by this author , and R. Christopher DoironR. Christopher Doiron More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal approach for management of varicocele is currently unknown. Existing evidence is of low quality with no randomized controlled studies comparing approaches. We provide the first population-based analysis of embolization vs surgical management of varicocele. METHODS: All patients in the province of Ontario who underwent treatment of their varicocele between April 1, 2002-March 31, 2012 were identified using ICES databases. The index intervention was considered the approach first used in the treatment-naïve patient – open surgery or embolization. The primary outcome was the rate of reintervention while secondary outcomes included complications and healthcare utilization. RESULTS: We identified 557,650 male patients with a varicocele diagnosis, of whom n=3,180 underwent an intervention and were included in the study – n=2,139(67%) underwent open varicocelectomy while n=1,041(33%) underwent embolization as their index intervention (Figure 1). Reintervention was more common amongst those who underwent embolization compared to those who underwent surgical management [n=97(9.3%) vs n=142(6.6%);p<0.01]. While controlling for demographics, regression analysis showed surgical varicocelectomy was still less likely to require reintervention [OR 0.68(0.52-0.90);p<0.01].Those who underwent surgical management had higher rates of complications requiring ED visits within 1 month of the procedure. This association was persistent on regression analysis, controlling for demographics [OR 1.69(1.27-2.25);p<0.01]. There was no difference in hospital admissions between the groups [OR 1.53(0.94-2.49);p=0.087].There was a weak association between socioeconomic status (SES) and type of index intervention with the least wealthy income quintile more likely to receive surgery [OR 1.27(1.01-1.60);p=0.04] while there was no difference based on rurality and age. CONCLUSIONS: This first population-based study to examine surgical management vs embolization for treatment of varicocele shows that surgery is less likely to require repeat intervention but with a modest increased risk of complications. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e397 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aidan Canil More articles by this author Wenbin Li More articles by this author Kingston Canada More articles by this author Premal Patel More articles by this author Winnipeg Canada More articles by this author Ben Mussari More articles by this author Timothy Hanna More articles by this author D. Robert Siemens More articles by this author R. Christopher Doiron More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract No. 605 Modern Search Analytics: What Are Patients Asking about Varicocele Embolization?

Abstract No. 605 Modern Search Analytics: What Are Patients Asking about Varicocele Embolization?

Abstract No. 151 Sonographic Findings and Clinical Outcomes after Embolization of Symptomatic Varicoceles

Abstract No. 151 Sonographic Findings and Clinical Outcomes after Embolization of Symptomatic Varicoceles

Abstract No. 239 Population Health Analysis of Fertility and Offspring Outcomes in Patients Undergoing Varicocele Embolization versus Varicocelectomy

Abstract No. 239 Population Health Analysis of Fertility and Offspring Outcomes in Patients Undergoing Varicocele Embolization versus Varicocelectomy

Varicocele Embolization: Interventional Radiologist's Perspective.

The goal of this article is to review the patient selection criteria, technical pearls, and outcomes of percutaneous varicocele embolization. This article will provide a brief overview of the history of the procedure, angiographic approach, and materials used in contemporary embolization. The success rates and complications of the varicocele embolization will also be discussed.

Эндоваскулярная эмболизация яичковой вены при варикоцеле. Клинический случай

Varicocele is a pathology characterized by dilation of the venous veins of the seminal canal. Currently, the incidence of varicocele among adolescent men aged 12-20 years is 10-20%, and among men suffering from infertility, it is detected in 45%. In clinical practice, there are several methods of treating varicocele: open or microsurgical laparotomy, surgical embolization and laparoscopic varicocelectomy. However, the frequency of relapses of varicocele varies and depends on the method of its treatment. Embolization performed using venography helps to accurately determine the condition of the vessels of the testicles. Therefore, in our article we will describe the advantages and possibilities of modern minimally invasive treatment of varicocele embolization, possible complications and results.

Abstract No. 393 Percutaneous varicocele embolization decreases the DNA fragmentation index for infertility treatment: a single-center review over 5 years

DNA fragmentation index is an increasingly utilized parameter in evaluation and management guidance for male infertility factors in couples seeking infertility treatment. The purpose of this study is to evaluate the safety and efficacy of percutaneous varicocele embolization on decreasing DNA fragmentation index (DFI) in patients seeking treatment for infertility.

Postvaricocele Embolization Pain Syndrome: A Case Series Report and Review of Current Treatment Strategies

Background: Orchialgia is not an uncommon complaint among men with varicocele, but postvaricocele embolization–related testicular pain has not been widely investigated. This study evaluates the phenomenon of postvaricocele embolization pain (PVEP) syndrome and examines the current strategies to treat this unusual complication. Methods and materials: A prospectively collected database of patients with PVEP who presented to a tertiary center was analyzed between January 2011 and January 2020 following internal ethics approval. Patient demographics, including other complications related to embolization, analgesic requirements, and pain scores (on a 10-point visual analog score), treatment strategies, Patient Global Impression of Improvement (PGI-I) score and overall satisfaction score (on a 5-point scale), were reviewed. All patients were reviewed for a minimum of 12 months. Results: A total of 20 men with a mean age of 33.8 (18–45) years old, presented with PVEP over 10 years. Most men received embolization on an average of 26.6 (18–48) months. The reasons for varicocele embolization include either isolated or combined orchialgia (15 men), subfertility (5 men), and cosmesis (6 men). Eighteen (90%) men underwent microscopic spermatic cord denervation (MSCD) and 2 patients elected for conservative measures. The average pain scores pre-MSCD and post-MSCD were 6.9 (4–9) and 1.4 (0–4) (p<0.001) with a significant reduction in analgesia requirements. Immediate improvement in pain score was reported in all the patients and this persisted at the 12 months review. Most men reported a high satisfaction score (of 4/5) and only one patient reported no change in symptoms after MSCD. Conclusion: PVEP is a unique complication and patients should be counseled on the potential risk of persistent orchialgia following embolization for varicocele. The MSCD appears to be an effective treatment option with high success and satisfaction rates.

10-year experience of Paediatric varicocele embolization in a tertiary centre with long-term follow-up

Paediatric varicocele embolization has many benefits over surgical ligation, but lacks published long-term data. We investigated technical and clinical outcomes in this under reported patient group. To evaluate technical success, complications and recurrence rates following varicocele embolization in paediatric patients. A single-centre retrospective review of procedural data and electronic notes of consecutive patients referred for varicocele embolization over a 10-year period was performed (February 2010-March 2020). The primary outcomes were technical success and clinical efficacy (lack of symptom recurrence). Secondary outcomes included complications, testicular vein size reduction and procedural parameters including radiation exposure. Chi-square analysis was used to identify predictors of clinical success. Follow-up involved outpatient clinical assessment and telephone interview. 40 patients (median age 15) were referred for left-sided symptomatic varicocele. Technical embolization success was achieved in 36/40 patients (90%), with 4 procedures abandoned (inaccessible vein). Embolization technique was platinum-based coils±sclerosant. There were no immediate or long-term procedural complications. 32/36 patients completed short term follow-up at a median interval of 2.8 months. 30/32 (93.78%) experienced early clinical success. We found a significant reduction in peritesticular vein size following embolization (pre-3.70 vs post-2.56mm, p=0.00017) and a significant relationship between varicocele grade and early clinical success (χ2=4.2, p=0.04), but not pre-treatment peritesticular vein size (χ2=0.02, p=0.88). 33/36 patients completed long-term follow-up (median 4.2 years, range 0.36-9.9 years) producing a late clinical success rate of 93.9% (31/33). No post procedural complications including hydroceles were identified. This study demonstrates technical success, matching rates described in adult patients which is reassuring and in support of embolization in the younger patient cohort. More importantly, the overall clinical success rate is comparable with previous embolization studies. Reassuringly, all symptom recurrences occurred early in follow-up, and there is a cogent argument for a single follow-up appointment at this juncture. Our long-term average follow-up duration, primarily gained via telephone interview, exceeds other studies. Although our study has the longest follow-up for varicocele embolization in children, it is limited by a few patients being lost to early and long-term follow-up. This is a recognised issue faced by studies attempting to follow-up benign conditions with a high clinical success rate. Paediatric varicocele embolization is a successful alternative to surgical ligation, with no complications and good clinical outcomes over a long-term follow-up.

Relevant Biological Effects of Varicocele Embolization with N-Butyl Cyanoacrylate Glue on Semen Parameters in Infertile Men.

Surgical treatment or varicocele embolization (VE) with sclerosing or mechanical embolic agents have been shown to improve the semen parameters of infertile men. The aim of this study was to evaluate the impact of VE using N-butyl cyanoacrylate (NBCA) glue on semen parameters in infertile men. From January 2014 to June 2018, infertile adult patients with stage 3 varicocele and an initial semen analysis showing at least one abnormal semen parameter, and who were successfully embolized with NBCA Glubran®2 glue, were retrospectively recruited. The availability of a second semen analysis after VE was mandatory for patient inclusion. The primary endpoint was the change in total sperm number (TSN) after VE. The other parameters of interest were progressive and total sperm motilities (Smot) at 1 h (H1), sperm vitality (SV) and morphology (SMor). One hundred and two patients were included. Eight patients presented null TSN before and after VE. Among the remaining 94 patients, a significant improvement in the median TSN after VE was shown (31.79 × 106/ejaculate [IQR: 11.10–127.40 × 106/ejaculate] versus 62.24 × 106/ejaculate [IQR: 17.90–201.60 × 106/ejaculate], p = 0.0295). Significant improvement in TSN was found for the 60 oligo- or azoospermic patients (p = 0.0007), whereas no significant change was found for the 42 patients with normal initial TSN (p = 0.49). Other parameters, such as progressive and total SMot, SV and SMor, also significantly improved after VE (p = 0.0003, 0.0013, 0.0356 and 0.007, respectively). The use of NBCA glue as an embolic agent for VE in infertile men with stage 3 varicocele significantly improves the semen parameters.

Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization.

We carried out a retrospective analysis of infertile couple data using several methodologies and data analysis techniques, including the application of a novel data mining approach for analyzing varicocele treatment outcomes. The aim of this work was to characterize embolized varicocele patients by ascertaining the improvement of some of their clinical features, predicting the success of treatment via pregnancy outcomes, and identifying data patterns that can contribute to both ongoing varicocele research and the more effective management of patients treated for varicocele. We retrospectively surveyed the data of 293 consenting couples undergoing infertility treatment with male varicocele embolization over a 10-year period, and sperm samples were collected before and at 3, 6, and 12 months after varicocele embolization treatment and analyzed with World Health Organization parameters—varicocele severity grades were assessed with medical assessment and scrotal ultrasound, patient personal information (e.g., age, lifestyle, and embolization complications) was collected with clinical inquiries, and varicocele embolization success was measured through pregnancy outcomes. Varicocele embolization significantly improved sperm concentration, motility, and morphology mean values, as well as sperm chromatin integrity. Following this study, we can predict that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance of conceiving after embolization treatment if his partners’ age is between 24 and 33 with an accuracy of 70.59%. Furthermore, male patients successful in achieving pregnancy following embolization are mostly characterized by having a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, and not working in a putatively hazardous environment.

Adolescent Varicocelectomy: Success at What Cost? Clinical Outcome and Cost Comparison of Surgical Ligation and Percutaneous Embolization

Objectives: Evaluate clinical outcome, recurrence, morbidity, and cost associated with laparoscopic surgical ligation versus percutaneous embolization of adolescent varicocele. We hypothesize that both approaches are similar in outcomes, complications, and cost. Materials and Methods: A retrospective review of 56 consecutive adolescent males, ≤18 years from 2006 to 2016 with clinical varicocele who underwent laparoscopic surgical ligation or percutaneous embolization. Patient demographics, operative time, postoperative complications, success, varicocele grade, recurrence, and hospital charges were abstracted. Results: Mean age was 14.2 ± 2.1 years; 48 (86%) patients having undergone laparoscopic surgical ligation and 8 (14%) percutaneous embolization. Intervention in 45 (80%) patients was for testicular hypotrophy (mean 27.4% ± 15.6%) and 11 (20%) for pain symptomology. Median follow-up was 17.5 months (range 1-65 months). After ligation, 2 (4%) patients developed hydroceles (1 with subsequent hydrocelectomy) and 6 (12%) varicocele recurrence. There were no cases of hydrocele or varicocele recurrence after percutaneous embolization. Twenty ligation patients had postoperative scrotal ultrasound demonstrating an increase in testicular volume by a reduction in difference in testicular volume from 27.3% ± 14.7% preoperatively to 11.2% ± 13.6% postoperatively (P < .001). There was significant difference in mean operative time between the groups (surgical ligation 41.3 minutes versus percutaneous embolization 117.9 minutes, P < .001) and hospital charges for the procedure (surgical ligation $3983 versus percutaneous embolization $18.165, P < .001). Conclusions: Contrary to our hypothesis, percutaneous embolization has seemingly lower rates of postoperative hydrocele and varicocele recurrence in comparison to surgical ligation but with three times the exposure to general anesthesia and at four times the price.

Varicocele Embolization: Patient Selection: Preprocedure Workup, and Technical Considerations

Varicocele refers to an abnormally dilated and tortuous pampiniform venous plexus within the spermatic cord. The prevalence of varicocele is reported to be approximately 15% in the general male population. Its incidence increases with age and has a higher incidence in infertile men. Varicocele treatment (surgical or interventional) is considered one of the most common therapies of reversible infertility in men. Percutaneous embolization offers nonsurgical, minimally invasive option for the treatment of varicoceles, requiring only minimal sedation. In this article, the authors review the clinical and technical details of percutaneous varicocele embolization with a summary of currently available evidence.

Abstract No. 99 Financial reimbursement in interventional radiology procedures: multicenter analysis within the Americas

To compare financial reimbursement costs related to interventional radiology procedures (IRP) across USA, Canada (Ontario) and Brazil Medicare Billing (based on RVU and CPT codes) obtained from a single institution was considered as the primary database for US billing. USA Procedure Reimbursement Fees (PRF) included billings in NON FAC PAR, NON FAC NON PAR, NON FAC LC, FAC PAR, FAC NON PAR and FAC LC categories. However, NON FAC PAR fees were utilized as a US Standard baseline for comparison with Ontario and Brazil. Brazilian private PRF were obtained from a single institution. Canadian billings were obtained from a single institution in Ontario (OHIP Database). Equivalency factor for standardization of PRF included the pre-COVID cost of living adjusted income (using proportionate household disposable income as a basis) and pre-COVID foreign exchange rate for each country (February 2020), relative to USA. All currency values were presented in US dollar equivalent. 32 of 45 procedures met inclusion criteria with PRF present for each country. Procedures with fees not available in 1 or more countries were excluded. Brazil-USA: 19 (59%) procedures demonstrated an average of 66% lower fees in Brazil as compared to USA. Some of these procedures include varicocele embolization, portal vein embolization, uterine fibroid embolization, Gastrojejunostomy tube placement and IVC filter placement. Only 12 (37%) procedures demonstrated an average of 219% higher fees in Brazil as compared to USA. Canada-USA: 22 (69%) procedures were underpaid in Ontario (-95% to -19%). Some of these procedures include biliary stent insertion, CT-guided visceral biopsy, port insertion, cholecystostomy tube, carotid stenting, hepatic radiofrequency ablation, thoracocentesis, mesenteric stenting and suprapubic catheter insertion. 1 (3%) procedure was similar in PRF (variance within ±5%). Variable PRF across nations has resulted in relatively low reimbursement fees in Brazil and Canada. Based on cost-of-living adjusted income and foreign exchange rate, a PRF reform is needed, in order to standardize IRP fees in Brazil, Canada and USA.

Improvement of semen parameters after coil embolization of varicoceles: a systematic review.

This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.

Radiation Exposure during Varicocele Embolization: Does Access Site and Treated Side Matter?

Purpose: The purpose of the study was to evaluate radiation exposure during varicocele embolization and correlate it with access site, embolized side, and complexity of varicoceles. Materials and Methods: This retrospective study included 39 adults who underwent varicocele embolization with a combination of coils and sclerosing agents between January 2015 and December 2018. Left-sided embolization was done in 26 patients and bilateral embolization in 13 patients. Jugular access was used in ten patients, whereas upper limb access was done in 29 patients. Dose area product (DAP) and total fluoroscopy time were collected and correlated to the treated side, access site, and complexity of varicoceles. Results: The mean fluoroscopy time for left varicocele embolization was 26.76 min, which was not statistically different (P = 0.16) compared to bilateral embolization (33.2 min). There was no statistical difference (P = 0.37) between the mean DAP for left embolization of 106,239 mGy.cm2 compared to bilateral DAP of 107,153 mGy.cm2. There was no difference in the mean DAP or fluoroscopy time between jugular vein access (DAP = 87,569 mGy.cm2, time = 34 min) and upper limb venous access (DAP = 113,086.8534 mGy.cm2, time = 28 min) with P = 0.64 and P = 0.14, respectively. There was no statistically significant correlation between the left varicocele Bähren classification and the fluoroscopy time (P = 0.52) or DAP (P = 0.76). Conclusion: This study finds no significant difference in DAP or fluoroscopy time between jugular and upper limb venous access or between left and bilateral embolization.