Varicocele

J Vasc Interv Radiol. 2000 Jul-Aug;11(7):859-64.
Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results.
Maleux G, Stockx L, Wilms G, Marchal G.
PURPOSE: Ovarian vein embolization has been used recently to treat pelvic congestion syndrome. The purpose of this study is to evaluate the clinical efficacy and safety of ovarian vein embolization in the treatment of symptomatic pelvic varices. MATERIALS AND METHODS: We performed ovarian vein embolization in 41 patients (mean age, 37.8 years; range, 30-58 years): 32 patients underwent unilateral embolization and nine patients underwent bilateral embolization. All had lower abdominal pain and pelvic varicosities were found on retrograde ovarian vein venography. Embolization was performed with a mixture of enbucrilate and lipiodized oil in all but one patient, in whom enbucrilate and minicoils were used. Initial technical success rate and clinical follow-up (1-61 months; mean, 19.9 months), conducted with use of mailed questionnaires, are reported. RESULTS: Initial technical success rate was 98%. Immediate complications were noted in two patients (4%) in the form of migration of some fragments of glue (used as embolic agent), which was treated conservatively. Clinical follow-up reveals variable symptomatic relief in 9.7% of cases and a total relief of symptoms in 58.5% of cases. Results in patients who had insufficient ovarian veins bilaterally were no better than those in patients for whom only the left ovarian vein was found insufficient. CONCLUSIONS: Transcatheter embolization of the ovarian veins is a safe and feasible technique leading to complete relief of symptoms in more than half of cases. No statistically significant difference in clinical outcome could be noted between patients presenting with bilateral insufficient ovarian veins, who underwent bilateral embolization, and patients presenting with an insufficient left ovarian vein, who underwent left unilateral embolization.

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J Vasc Interv Radiol. 2002 Feb;13(2 Pt 1):171-8.
Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain.
Venbrux AC, Chang AH, Kim HS, Montague BJ, Hebert JB, Arepally A, Rowe PC, Barron DF, Lambert D, Robinson JC.
PURPOSE: The purpose of this study was to analyze the impact of transcatheter embolotherapy on pain perception and menstrual cycle in women with chronic pelvic pain caused by the presence of ovarian and pelvic varices (ie, women with pelvic congestion syndrome or pelvic venous incompetence). MATERIALS AND METHODS: From July 1998 to August 2000, 56 patients (mean age, 32.3 y) were treated for chronic pelvic pain. Diagnostic venography of the ovarian veins was followed by transcatheter embolotherapy with a sclerosing agent and coils. A second session was completed to embolize the internal iliac veins in 43 of 56 patients. Visual analog scales (VAS) used to measure pain were administered before embolization and at 3-, 6-, and 12-month follow-up. Questionnaires regarding menstrual history were used as part of the postprocedural analysis. RESULTS: Percutaneous transcatheter embolotherapy of ovarian and pelvic varices was technically successful in 56 of 56 patients (100%); three patients developed recurrent varices, two of whom were treated with repeat transcatheter embolotherapy. Two patients, early in the experience, had complications in which coils placed in the internal iliac veins embolized to the pulmonary circulation; the coils were snared without clinical sequelae. On the VAS, the mean baseline pain level was 7.8 (range, 3.2-9.8; n = 56); at 3-month follow-up, it was 4.2 (range, 0.0-7.2; n = 56); at 6 months, 3.8 (range, 0.0-6.7; n = 41); and at 12 months, 2.7 (range, 0.0-6.9; n = 32). Differences were significant (P <.001) between baseline pain levels and those at all follow-up intervals (ie, 3, 6, and 12 months). The mean decrease in VAS was 5.1 (65% decrease). The clinical follow-up in this series ranged between 6 and 38 months; the mean was 22.1 months. Regarding the impact of embolization on menstruation, all 24 patients responding to questionnaires indicated no change in menstrual cycle. CONCLUSION: For patients with ovarian/internal iliac varices, transcatheter embolotherapy provides a nonsurgical treatment option. There is a significant decrease in pain based on VAS without any notable impact on menstrual cycle.

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Radiol Med. 2003 Jan-Feb;105(1-2):76-82.
Percutaneous treatment of pelvic congestion syndrome.
Pieri S, Agresti P, Morucci M, de' Medici L.
Servizio di Radiologia Vascolare ed Interventistica, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy. INTRODUCTION: Pelvic congestion syndrome and chronic pelvic pain are enigmatic clinical conditions that may have considerable impact on the social and relational life of women. Patients usually complain of lower abdominal pain that has lasted for more than six months, is intermittent or continuous, and may become worse during menses or after a hard day's work. Sometimes the pain is accompanied by dyspareunia, urinary urgency or constipation. The traditional treatment of pelvic congestion syndrome has included both medical (analgesics, hormones) and surgical approaches (hysterectomy, ovarian vein ligation). Recently, percutaneous transcatheter embolization has also been proposed. We report our experience with the percutaneous management of pelvic congestion syndrome, using the transbrachial approach and sclerosis alone. MATERIAL AND METHODS: Between 1996 and 2001, 33 women underwent percutaneous treatment for pelvic congestion syndrome at our department. All the women had chronic pelvic pain which was continuous in 69%; 20 patients had dyspareunia, whereas 8 had urinary urgency; 72% took analgesics on a regular basis. All the patients underwent percutaneous treatment of pelvic congestion syndrome on a outpatient basis in a radiological suite, after receiving local anaesthesia. Sclerosis was performed with 3% sodium tetradecyl sulfate. Follow-up consisted of a questionnaire at one month and gynaecological and ultrasound examinations at 6/12 months. RESULTS: The pre-procedural ultrasound examination had revealed a mean diameter of 4.5 mm for the right ovarian vein and of 6.3 mm for the left. We found one pelvic congestion syndrome on the right, 11 on the left and 21 bilaterally. At the one-month follow-up, chronic pelvic pain was present in 13 patients (39%); the pain was continuous in three and intermittent in ten. At the follow-up after 6/12 months the symptoms were unchanged. Ultrasound revealed a reduction in periovarian varicosities, recording a mean diameter of 3.19 mm on the right and 4.5 mm on the left. Symptoms persisted in women with pelvic varicosities measuring over 5 mm at ultrasound. CONCLUSIONS: Pelvic congestion syndrome and chronic pelvic pain that do not respond to medical therapy can be resolved by percutaneous management. Less expensive than surgery, this therapeutic option is safe, effective, minimally invasive and capable of restoring patients to normal function. We propose the transbrachial approach as the first-choice treatment for bilateral pelvic congestion syndrome.

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Pediatr Radiol  2001 Jul;31(7):515-7

Percutaneous transfemoral testicular vein embolisation in the treatment of childhood varicocoele.

Clarke SA, Agrawal M, Reidy J.

Depertment of Paediatric Surgery, University Hospital Lewisham, London, UK.

RESULTS: …90% had satisfactory embolisations. There were five technical failures (10%)due to a combination of abnormal venous anatomy and severe venospasm. CONCLUSIONS: We believe that where the expertise necessary for testicular embolisation is available, it should be offered as the intervention of first choice. Surgery should be reserved for the rare cases where embolisation is not possible or when recurrence has occurred.

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J Pediatr Surg  2002 May;37(5):783-5

Percutaneous embolization of varicocele in children: A Canadian experience.

Alqahtani A, Yazbeck S, Dubois J, Garel L

Montreal, Quebec..

BACKGROUND/PURPOSE: The importance of early treatment of varicocele, to prevent testicular damage is widely accepted. Surgical treatment of varicocele has been the standard method of therapy, but recently a less invasive procedure was introduced and utilized mostly in Europe. The authors reviewed their experience with percutaneous embolization and sclerotherapy to assess the feasibility and outcome of this approach in children.

RESULTS: A total of 89.1% of those who were injected have satisfactory results (cured or improved) without the need for further procedures. Six patients required surgery post-percutaneous procedure, 4 because of persistent or recurrent varicocele and 2 because of technical failure. CONCLUSIONS: Percutaneous embolization is a safe and effective treatment of varicocele in children with technical success in 95%and therapeutic success in 89%. It now is the authors' first treatment modality for this disease.

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J Pediatr Surg  2001 May;36(5):767-9

Results and complications of laparoscopic surgery for pediatric varicocele.

Esposito C, Monguzzi G, et al

Magna Graecia University of Catanzaro, Italy.

BACKGROUND: … to evaluate the results and complications of laparoscopic varicocelectomy in children. RESULTS: At an average follow-up of 26 months, there were 19 (9%) postoperative complications: 14 children had a left hydrocele, 3 children a scrotal emphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicocele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo's. CONCLUSIONS: Hydrocele seems to be the most frequent postoperative complication and a potential problem, especially in children operated on with the Palomo procedure.

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Ann Urol (Paris)  1999;33(3):203-9

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Br J Radiol  2000 Mar;73(867):293-7