Safety and effectiveness of transcatheter foam sclerotherapy for testicular varicocele with a fluoroscopic tracing technique

Purpose: To evaluate the safety and effectiveness of percutaneous sodium morrhuate foam sclerotherapy of varicoceles with the use of fluoroscopic tracing technique.

Materials and methods: At baseline and at 6-month follow-up, 58 patients with grade II/III left varicocele (mean age, 21.1 years; range, 19-25 y) with abnormal semen parameters underwent clinical assessment, Doppler ultrasonography, and semen analysis between September 2002 and January 2007. In all 58 cases, selective catheterization of the spermatic vein was performed with a right transfemoral approach. The standardized sclerosing foam was prepared with the Tessari method. Foam sclerotherapy was performed by the "filling-defects technique" under fluoroscopic guidance, with the sclerosing foam visualized as translucent filling defects in the internal spermatic vein filled with contrast medium during injection of the foam.

Results: Technical success was achieved in all patients. Sodium morrhuate foam dose ranged from 2 mL to 8 mL (0.4-1.6 mL of solution) per patient, with an average dose of 5.3 mL (approximately 1.1 mL of solution). There were no major side effects or complications of the procedure. At 6-month follow-up, 53 of 58 patients (91.4%) reported disappearance of previous varicoceles and five had slight, asymptomatic residual varicoceles. Seminal parameters showed significant increases after treatment. No major complications occurred, and no recurrent/persistent varicoceles were found.

Conclusions: Fluoroscopy-guided transcatheter foam sclerotherapy is a safe and effective approach for varicoceles, and the filling-defects technique under fluoroscopy is a feasible method for tracing the sclerosing foam.