Phlebography: why it is important to study radiological imaging of spermatic veins.
OBJECTIVE
We delineate the role of phlebography which is a standard procedure during antegrade and retrograde sclerotherapy of idiopathic varicoceles.


METHODS
Based on our experience with antegrade sclerotherapy in 5,254 adults and adolescents we present typical phlebographies of the internal spermatic vein and radiological images after irregular cannulation of different arteries and veins on the scrotal floor. The sequalae of misinjections and paravascular application of the sclerosing agent polidocanol are discussed. A radiological classification of venous drainage roots of the pampiniform plexus is introduced on the basis of 236 consecutive antegrade phlebographies. The findings are compared with the results of retrograde phlebography previously given in literature.


RESULTS
Phlebography helps to ascertain that sclerotherapy is performed in an anatomically appropriate manner. Thus, misinjections and paravascular applications of polidocanol can be ruled out. Antegrade phlebography enables to visualize a high rate of side veins and collaterals of the internal spermatic vein and thus seems to be equivalent to the retrograde imaging in tracing the additional drainage roots of the pampiniform plexus. These additional roots are considered to be the source of persisting varicoceles after surgical treatment.


CONCLUSIONS
Phlebography is needed to achieve good results after sclerotherapy of varicoceles and to minimize the toxic side effects of polidocanol. Finally it is a prove that the treatment has been performed accurately for forensic reasons.
Department of Urology, General Hospital Hamburg-Barmbek, Germany. akbarmbekurologie@compuserve.com
Roland
R
Tauber
Dietrich
D
Pfeiffer
Thorsten
T
Bruns
D034861:Abdominal Wall / Q000473:pathology; D002404:Catheterization; D002985:Clinical Protocols; D006801:Humans; D008297:Male; D008318:Malpractice; D009336:Necrosis; D010690:Phlebography / Q000379:methods*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000009:adverse effects / Q000627:therapeutic use; D015911:Sclerotherapy; D013085:Spermatic Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D014646:Varicocele / Q000000981:diagnostic imaging* / Q000628:therapy; D014680:Veins / Q000473:pathology
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols