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A Journal on Phlebology
Acta Phlebologica 2004 December;5(2-3):51-6
Update on varicocele sclerotherapy
G. Mazzoni G. 1, Minucci S. 2, Mangia G. 1, Antignani P. 3
1 Unit of Paediatric Surgery, S. Camillo-Forlanini Hospital, Rome, Italy;
2 Unit of Interventional Vascular Radiology, S. Camillo-Forlanini Hospital, Rome, Italy;
3 Unit of Angiology, S. Giovanni Addolorata Hospital, Rome, Italy
AIM: The aim of our study is to evaluate the sclerotherapy techniques used in the management of varicocele.
METHODS: Personal experience in patients treated between June 2000 and June 2003 with a minimum follow-up of 12 months has been reviewed: 342 patients submitted to retrograde sclerosis (RS), 310 to antegrade sclerosis (AS) and 149 to ante/retrograde sclerosis (A/RS).
RESULTS: An analysis has been made of the impossibility to perform sclerosis which occurred only with RS (6%) and of failures: 4.3% with RS, 3.5% with AS and <1% with A/RS. In the group submitted to RS, a significant difference can be seen both as far as concerns the possibility to achieve sclerosis and success rate, depending upon whether it is the first operation, postoperative or post RS recurrence. This difference was not found in the group of patients submitted to AS or A/RS.
CONCLUSION: A/RS has several advantages compared to use of the 2 techniques performed separately. 1) Easier retrograde cannulation of the spermatic vein observed via the antegrade route. 2) Complete opacification of the entire circulation on account of the greater pressure following injection of the contrast medium with opposite flows. 3) Synergic action of the sclerosing drug injected from 2 opposite directions. Having 3 possibilities available means that the most suitable technique can be selected for the individual patient. RS is indicated in young adults (>16 years) on account of the particular mini-invasiveness, even if the percentage of failures is greater; AS in paediatric patients, since retrograde catheterisation is more difficult; A/RS, on account of the greater possibility of success, is preferred in adult infertile men, in bilateral cases and in patients with recurrence, regardless of the technique previously used.