The influence of antegrade scrotal sclerotherapy on the diameter of the spermatic cord veins in men with varicocele.
OBJECTIVE
To assess the influence of antegrade scrotal sclerotherapy on diameter of veins of the pampiniform plexus of the spermatic cord by comparison of the vein diameter before and after the operation in patients with varicocele; to evaluate the rate of recurrence of the disorder after antegrade scrotal sclerotherapy and significance of color Doppler ultrasonography in the diagnosis of varicocele; and to estimate the efficacy of the treatment.


METHODS
Forty-one patients with various degrees of varicocele treated by antegrade scrotal sclerotherapy were included in the study. The size of the pampiniform plexus of veins of the patients was evaluated clinically during physical examination, and its diameter was measured by color Doppler ultrasonography before and after the operation in the upright and the supine positions during the Valsalva maneuver and without it.


RESULTS
After antegrade scrotal sclerotherapy, the diameter of the studied veins was found reliably decreased while examined in all four patient's examining positions, independently of the degree of the preoperative varicocele and recurrence of the disorder. The postoperative decrease of diameter of veins was inversely proportional to the degree of varicocele, i. e. the diameter of veins in the third degree varicocele became most reduced. The recurrence of varicocele after antegrade scrotal sclerotherapy was revealed in 21.9% of the operated patients. The diameter of veins in the recurrent varicocele, assessed by physical examination, and venous blood reflux, detected by ultrasound, reliably decreased in the upright position of patients (p<0.005), whereas in the supine position, diameter of the studied veins remained almost the same as it was before the operation (p=0.9).


CONCLUSIONS
After antegrade scrotal sclerotherapy, the diameter of the varicocele vein decrease was statistically significant. It was mostly expressed after the operation in the cases of the third degree varicocele. The postoperative diameter of veins in the recurrent varicocele of the examined patients in the upright position was also reliably smaller than before the operation, but it practically did not differ from the preoperative diameter when the patients were examined in the supine position.
Mickevicius
Ramūnas
R
Clinic of Urology, Kaunas University of Medicine Hospital, Eiveniu 2, 50010 Kaunas, Lithuania. rami@takas.lt
Zilaitiene
Birute
B
Zdanavicius
Rimantas
R
D000293:Adolescent; D000328:Adult; D006801:Humans; D008297:Male; D010808:Physical Examination; D011187:Posture; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods; D012680:Sensitivity and Specificity; D013085:Spermatic Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D016683:Supine Position; D018615:Ultrasonography, Doppler, Color; D014636:Valsalva Maneuver; D014646:Varicocele / Q000145:classification / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014680:Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology