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J Pediatr Urol. 2017 Jun;13(3):305.e1-305.e6. doi: 10.1016/j.jpurol.2016.12.018. Epub 2017 Jan 29.

Antegrade sclerotherapy in adolescent varicocele patients.

Author information

1
Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK.
2
Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK. Electronic address: Raimondo.cervellione@cmft.nhs.uk.

Abstract

INTRODUCTION:

In the 1970s, Tauber described the antegrade sclerotherapy technique to treat varicoceles, and reported a 10% recurrence rate. The present study aimed to evaluate paediatric success rates and the effect of modifications to the surgical technique.

METHODS:

A prospective study was performed of all adolescent patients undergoing antegrade sclerotherapy surgery. Each patient had an idiopathic varicocele with spontaneous venous reflux on Doppler examination, and underwent cannulation of a pampiniform plexus vein via a scrotal incision under general anaesthetic. Aethoxysklerol® 3% (2 ml/kg) maximum 3 ml was injected into the pampiniform plexus vein under fluoroscopic monitoring. Success was assessed by clinical examination and Doppler ultrasound 3, 6 and 9 months after surgery. Data were presented as median (interquartile range). Patients were split into three groups: Group A - liquid sclerotherapy with Y connector; Group B - liquid sclerotherapy direct to cannula; and Group C - foam sclerotherapy direct to cannula. Fisher's exact test was used to compare the success rates in each group.

RESULTS:

A total of 91 patients underwent antegrade sclerotherapy. The median age was 14.8 years (range 13.7-15.5). Eleven persistent varicoceles occurred and were diagnosed by Doppler ultrasound. The success rate of surgery was 58% in Group A, 90% in Group B and 96% in Group C. Success was significantly higher in Group B and Group C compared with Group A. No testicular atrophy occurred; two wound infections, two haematomas and one hydrocele were recorded (Table).

CONCLUSION:

Introduction of antegrade sclerotherapy in the adolescent population resulted in a safe and cost-effective method for the management of adolescent varicocele. Several modifications to the technique have been introduced to achieve a high success rate (96%) with minimal complications.

KEYWORDS:

Adolescent; Antegrade sclerotherapy; Varicocele

PMID:
28215837
DOI:
10.1016/j.jpurol.2016.12.018
[Indexed for MEDLINE]

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