Varicocele Embolization Efficacious
Three quarters of patients experienced complete or partial resolution of pain following the procedure.
WASHINGTON D.C.—Percutaneous varicocele embolization is safe and effective for treating painful varicoceles and may improve sperm concentration in infertile men, according to Canadian researchers.
The researchers studied 64 men who underwent percutaneous varicocelectomy with coils (36 patients for pain and 28 patients for primary and secondary infertility). In men who had pain, the vast majority (75%) had a complete or partial resolution after the procedure.
“In the men with infertility, we raised their sperm concentration and number of motile sperm,” said lead investigator Amol Mujoomdar, MD, an interventional radiology fellow at the
Dr. Mujoomdar, who presented the study findings here at the Society of Interventional Radiology annual meeting, also observed: “Patients are now demanding more minimally invasive procedures, so we are forming a database to directly compare percutaneous varicocele embolization to surgical ligation. This approach is less invasive and it has a much faster recovery time.”
The series included 22 bilateral and 42 left-side only varicocele embolizations. The technical success rate was 86% for all the procedures (95% for left and 76% for right). Twenty-eight percent of the treated patients had recurrent varicoceles following previous surgical ligation.
In the population with clinically symptomatic varicoceles, approximately 46% of the men had almost complete/complete resolution, 29% of the men had partial resolution, and 25% had persistent pain following percutaneous varicocele embolization. The mean follow-up time was 17 months (a range of 6-32 months). The men treated for infertility had a significant mean increase in sperm concentration of 14.2 million/mL.
“I think it is an option as a first-line therapy for pain or infertility and it is also something to consider when there has been surgical failure,” Dr. Mujoomdar said.
“It could be used as a second-line after a surgical failure. The effect on the sperm parameters tends to occur quicker with the embolization compared to surgical ligation. This has not been proven, but it is showing up anecdotally. We think it may be due to a shock that the testicle receives with surgical ligation where the embolization may not be occurring.”
No major complications occurred in this series, he said. Among the 64 subjects, only two experienced minor contrast allergies.