Varicocele embolization: comparing the number and material composition of coils with the recurrence rate
Number:27ESURABS0048
Type:Scientific Electronic Presentation
Authors: Rodrigo Cordeiro, Pedro Guilherme Magalhães, João Filipe Costa, Alfredo Gil Agostinho, Vítor Carvalheiro, Paulo Donato
Keywords:Varicocele; embolization; coils
SECTIONS
Objectives

Varicocele is the tortuosity and dilation of the pampiniform venous plexus, whose etiology is still debated and probably multifactorial. However, the most common cause described in the literature is valvular dysfunction with the consequent retrograde flow in the internal spermatic vein [1,2]. It is more frequent on the left (80-90% of cases) because the hydrostatic pressure is greater in the left internal spermatic vein due to the angle formed between this and the left renal vein [1,3]. It is a common condition, with a prevalence of around 15% in the male population [3-5].

The most common clinical presentation of varicocele in adults is infertility, followed by scrotal pain and discomfort. It is considered one of the most common causes of reversible infertility in men. There is evidence that varicocele is associated with a progressive decline in testicular function resulting...

...read more


Material and methods

We performed a retrospective analysis of 83 male patients undergoing varicocele embolization procedures from January 2018 to December 2020.

The following data were processed: demographic data; the reason for referral; clinical data; grade and bilaterality of the varicocele; number and type of coils used and varicocele recurrence rate, including the comparison of these last three variables.

 

Study population

All patients undergoing the procedure were referred from the Urology department for infertility or testicular pain after ultrasound confirmation of varicocele. Patients without sufficient records and patients whose phlebography during the procedure was normal were excluded.

Varicocele was classified on Doppler ultrasound according to the Sarteschi classification [9] (Fig.1):

- Grade I: reflux at the groin level,...

...read more

Varicocele in ultrasound. Dilation of the pampiniform plexus (caliber >3mm) is observed (A), with regurgitation during the Valsalva maneuver in color Doppler (B) in a patient with grade 3 varicocele referred for treatment by embolization. Serviço de Imagem Médica, Centro Hospitalar e Universitário de Coimbra, 2021.
Varicocele embolization. A selective venogram of the left internal spermatic vein (A) before embolization shows a dilated pampiniform plexus (B). Postembolization venogram demonstrates cessation of flow (C), visualizing the coils at the level of the inguinal ligament (arrow). Serviço de Imagem Médica, Centro Hospitalar e Universitário de Coimbra, 2021.

Results

Of the 83 patients evaluated (average age, 35.86 years), 44 (53%) were due to infertility, 3 (4%) were due to testicular pain, and in 36 patients (43%) the reason for the referral was not clear in clinical records.

In the Doppler ultrasound before the procedure, 25 patients (30%) had bilateral varicocele, and 58 (70%) had varicocele only on the left. The grade of varicocele was missing in 33 patients (39.8%). Of patients where it was possible to obtain the grade, varicocele on the left tended to have a higher grade (mean grade, 3) than the right (mean grade, 1).

In most patients with bilateral varicocele, the right varicocele was not confirmed on venography during the procedure, so only two patients (2%) with bilateral varicocele were embolized to the right and left.

In 62 patients (75%) platinum coils were used; in 7 patients (8%) inconel coils and 14 patients...

...read more


Conclusions

There is no statistically significant association between the number and material composition of coils used in varicocele embolization with the recurrence rate.

 

References

1. Favard N, Moulin M, Fauque P, Bertaut A, Favelier S, Estivalet L, et al. Comparison of three different embolic materials for varicocele embolization: retrospective study of t olerance, radiation and recurrence rate. Quant Imaging Med Surg. 2015 Dec;5(6):806–14.

2. Perdikakis E, Fezoulidis I, Tzortzis V, Rountas C. Varicocele embolization: Anatomical variations of the left internal spermatic vein and endovascular treatment with different types of coils. Diagn Interv Imaging. 2018 Oct;99(10):599–607.

3. Wadhwa V, Kashanian JA, Schiffman M, McClure TD. Varicocele Embolization: Patient Selection: Preprocedure Workup, and Technical...

...read more