POSTSURGICAL RECURRENT VARICOCELE - EFFICACY OF INTERNAL SPERMATIC VENOGRAPHY AND STEEL-COIL EMBOLIZATION

Objective To delineate the venographic anatomy of the varicoceles whic h recur following conventional inguinal varicocele ligation and to det ermine the therapeutic efficacy of steel-coil embolization as assessed by improvements in seminal parameters and paternity. Patients and met hods Thirty-nine patients with postsurgical recurrent varicoceles unde rwent bilateral internal spermatic venography approached through the r ight femoral vein. The collateral Venous channels were identified and occluded using appropriate sizes of steel coils. Results The procedure was technically successful in 33 patients (85%), Analysis of the 33 v enograms showed a unilateral left-sided recurrent varicocele in 28 pat ients (85%) and bilateral recurrent varicoceles in five patients (15%) . The mid and lower parallel collateral channels were observed in 27 p atients (82%), The recurrences were treated easily with stainless stee l-coil embolization. Five patients were lost to follow-up. Of the rema ining 28 patients the sperm count and motility became normal in 16 (57 %); only the motility improved in three patients (10%) while in nine p atients (33%) there were no changes in either of the seminal parameter s. Five patients achieved paternity. Conclusions Internal spermatic vc nography allowed a precise anatomical definition of the recurrent vari cocele and the use of steel-coil embolization provided satisfactory im provements in sperm quality and paternity.