New Varicocele Technique Shows Promise
Melih Arici, MD
TAMPA, Fla.—Percutaneous varicocele embolization using a sclerosant agent and pushable fibered coils is a promising therapeutic option that could help improve outcomes, according to researchers.
“We found that with strategic positioning of pushable coils and with the use of a sclerosant agent we could treat collaterals and improve success,” said investigator Melih Arici, MD, Assistant Professor of Interventional Radiology at Yale University School of Medicine in New Haven, Conn. “Our results indicate that this approach is as good as a surgical option. We also have a lower complication rate and patients go back to work the next day.”
Historically, he said, the recurrence rate of varicoceles following surgical treatment is up to 15%. New surgical techniques have resulted in recurrence rates closer to 5%, with some microsurgical techniques associated with even better results.
He and his colleagues studied 54 young men with varicoceles who were treated with the new technique between September 2004 and August 2008. The men had a mean age of 21 years. Clinicians packed pushable fibered coils into the distal internal spermatic vein (ISV) at the level of the inguinal canal. They then injected undiluted contrast material during a valsalva maneuver distally into the ISV beyond the inguinal set of coils and into parallel collateral veins that were not apparent on the initial venograms. They injected 2% sodium tetradecyl sulfate foam in 2-3 mL aliquots to displace the static contrast material, until parallel collaterals were no longer apparent. Following deployment of a second set of coils at the level of the upper third of the sacroiliac joint, the interventionalists injected additional foam.
The treatment was successful in all men, according to investigators. The primary technical success rate was 98% (57 out of 58 procedures; the one patient who had treatment failure also had previously failed surgical treatment).
The clinicians observed no procedure-related complications, although 10 patients (18%) experienced mild self-limited pampiniform phlebitis. The researchers completed follow-up of 47 patients by ultrasound and/or physical examination. The remaining patients were lost to follow-up. Three patients had recurrences; of these, two were successfully retreated.
“The urologists who we work with agree that in a younger patient group a noninvasive method is preferable because there are fewer complications and because the patients can be up and back at work the next day,” Dr. Arici told Renal & Urology News.
“We found that with this intravascular treatment the recurrence rates and infection rates were the same as what you would see with surgery. In addition, our technique does not burn any bridges for future treatments. So we are excited about this and we would like to start approaching fertility clinics about adopting this.”
Treatment costs associated with varicocele embolization using sodium tetradecyl sulfate foam are comparable to those of surgical varicocele repair, he said. He added, however, that transcatheter approach appeals to patients because it requires little down time.