Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate--outcome in 244 patients.
OBJECTIVE
To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam.


METHODS
The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test.


RESULTS
Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77).


CONCLUSIONS
TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.
Gandini
Roberto
R
Department of Diagnostic Imaging, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Konda
Daniel
D
Reale
Carlo Andrea
CA
Pampana
Enrico
E
Maresca
Luciano
L
Spinelli
Alessio
A
Stefanini
Matteo
M
Simonetti
Giovanni
G
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods; D006801:Humans; D007248:Infertility, Male / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D008297:Male; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods*; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use*; D016896:Treatment Outcome; D014646:Varicocele / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate