title: Antegrade sclerotherapy in adolescent varicocele patients.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK.
authors.forename: D J B
authors.initials: DJB
authors.lastname: Keene
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK. Electronic address: Raimondo.cervellione@cmft.nhs.uk.
authors.forename: R M
authors.initials: RM
authors.lastname: Cervellione
mesh_terms: D000293:Adolescent; D006801:Humans; D008297:Male; D010690:Phlebography; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014646:Varicocele / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Adolescent; Antegrade sclerotherapy; Varicocele