title: Surgical outcomes after modified antegrade scrotal sclerotherapy: a prospective analysis of 700 consecutive patients with idiopathic varicocele.
abstract: OBJECTIVE
  We analyzed the surgical outcomes of antegrade scrotal sclerotherapy in a large, prospective, multisurgeon, consecutive series of patients treated for idiopathic varicocele.
  
  
  METHODS
  We prospectively collected data on 697 consecutive patients undergoing antegrade scrotal sclerotherapy between 1997 and 2005. For every patient we evaluated age, side, clinical and Doppler ultrasound grade, and seminal impairment. Perioperative complications were evaluated 1 month after surgery. At 12 months after antegrade scrotal sclerotherapy all patients underwent Doppler ultrasound. In those with seminal impairment semen analysis was also performed. Failure was defined as at least Doppler grade 1 varicocele.
  
  
  RESULTS
  Median age of the 697 analyzed patients was 28 years. Mean surgical time was 15 minutes. All surgeries were performed using local anesthesia and no intraoperative complications were observed. All patients were discharged home within 4 hours. Postoperatively complications developed in 35 patients (5%) and failure occurred in 63 (9%). Persistent reflux was observed in 6.5% of adolescents, in 9.4% of adults and in 7.5% of patients with recurrent varicocele. Failure rates were similar for different grades and sides. The failure rate was significantly higher in patients treated by surgeons during the learning curve (p = 0.007). In the 414 patients with seminal impairment median sperm count and the median percent of progressive motility and normal forms significantly improved after surgery (p <0.001).
  
  
  CONCLUSIONS
  Considering the low persistence and complication rates in all patient categories (adolescents, adults, first diagnosis, and bilateral and recurrent disease) antegrade scrotal sclerotherapy can be proposed as a safe and efficacious first choice treatment for varicocele. A specific learning curve is required to achieve the best outcome.
authors: Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
authors: Antonio
authors: A
authors: Galfano
authors: Giacomo
authors: G
authors: Novara
authors: Massimo
authors: M
authors: Iafrate
authors: Simonetta
authors: S
authors: Fracalanza
authors: Giovanni
authors: G
authors: Novella
authors: Stefano
authors: S
authors: Cavalleri
authors: Walter
authors: W
authors: Artibani
authors: Vincenzo
authors: V
authors: Ficarra
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008297:Male; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods; D012611:Scrotum; D013076:Sperm Count; D013081:Sperm Motility; D014646:Varicocele / Q000601:surgery / Q000628:therapy*