Antegrade sclerotherapy in adolescent varicocele patients

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


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.

MeSH terms

  • Adolescent
  • Humans
  • Male
  • Phlebography
  • Postoperative Complications / epidemiology*
  • Prospective Studies
  • Recurrence
  • Sclerotherapy / adverse effects
  • Sclerotherapy / methods*
  • Treatment Outcome
  • Ultrasonography, Doppler
  • Varicocele / diagnostic imaging
  • Varicocele / therapy*