Varicocele retrograde embolization with boiling contrast medium and gelatin sponges in adolescent subjects: a clinically effective therapeutic alternative

Purpose: Varicoceles occur in approximately 15% of adolescent male subjects and may impair future fertility. The present study describes a varicocele treatment technique involving percutaneous retrograde embolization with boiling hot contrast medium and gelatin sponge pledgets.

Materials and methods: A retrospective review of medical records and imaging of all patients who underwent percutaneous retrograde varicocele embolization from 2005 to 2010 was performed. Pre- and postembolization symptoms, physical findings, and ultrasound findings were documented. Fifteen patients (16 embolizations) were identified, with an average age of 15.9 years (range, 12-18 y). Nine were referred because of persistent varicocele after surgical ligation. Three had grade 2 and nine had grade 3 varicoceles. Two had grade 1 varicoceles; one was painful and one was associated with poor semen quality. One varicocele was not clinically evident, but was associated with persistently decreased testicular size. Nine patients had pain or discomfort, and six had no discomfort. Clinical resolution was defined by a combination of symptom resolution and a lack of physical examination findings of varicocele or findings of treated varicocele.

Results: Fifteen of the 16 embolizations (94%) were technically successful. Clinical resolution was documented in 14 of 15 patients (95%); one patient experienced a recurrence at 30 months, which was successfully reembolized. One patient experienced temporary paresthesia of the left thigh. There were no major postprocedural complications. Mean follow-up duration was 11 months.

Conclusions: Retrograde embolization of varicoceles in adolescent subjects with the use of boiling hot contrast medium and gelatin sponges is a promising technique that appears effective.