Varicocele Embolization after Surgical Failure

Background: Varicocele is a common condition affecting up to 15 % of young adult males. It is associated with chronic scrotal pain and it can found in up to 81 % of infertile males. Surgery is the classic treatment for varicocele, however failure rates may reach up to 15 %. We aim to describe post-surgical angiographic patterns and assess both safety and efficacy of embolization for treatment of varicocele after surgical failure (residual or recurrent). Method(s): Inclusion criteria were symptomatic varicocele (pain or infertility) diagnosed by scrotal ultrasonography, presenting more than 3 months after previous surgical treatment. All patients underwent endovascular transcatheter retrograde varicocele embolization, under local anesthesia via right femoral vein or right internal jugular vein. We had no restrictions regarding embolization method/material. Peri-operative complications; procedure time; radiation dose; pre/post-embolization (3 months): pain score, scrotal ultrasonography and semen analysis were recorded. Result(s): Ten consecutive patients were recruited. Seven suffered from chronic scrotal pain and four from infertility; eight patients had left varicocele and only two patients had bilateral varicoceles. Eight procedures were done via femoral approach and two were jugular. In nine procedures n-butyl cyanoacrylate was used and only one procedure was done using sodium tetradecyl sulphate 3 % foam. No serious perioperative complications were encountered; only one patient developed hydrocele one week after operation that subsided with conservative management. Pain score, scrotal ultrasonography and semen analysis significantly improved in nine patients. Angiographic patterns of post-surgical varicoceles are described through original images. Conclusion(s): Varicocele embolization after surgical failure is safe and effective, however larger sample size is needed to consolidate the conclusion.