Dm. Dewire et al., CLINICAL OUTCOME AND COST COMPARISON OF PERCUTANEOUS EMBOLIZATION ANDSURGICAL LIGATION OF VARICOCELE, Journal of andrology, 15, 1994, pp. 38-42
We reviewed the records of 81 consecutive subfertile men with oligospe
rmia and/or asthenospermia, treated for varicocele with either percuta
neous embolization or surgical ligation between 1987 and 1991, and com
pared the outcomes and costs of the two procedures. All men had presen
ted with infertility of at least 6 months duration, and in most cases
female factors had been previously evaluated and treated. Patients wer
e offered a choice of embolization or ligation of the internal spermat
ic vein. Forty-five men (56%) underwent ligation, and 36 men (44%) opt
ed for embolization. The mean age, serum follicle-stimulating hormone,
pretreatment sperm density, motility, and concentration of motile spe
rm were similar for the two groups. Seminal quality improved in 65% of
all patients after varicocele ablation (46 of 71). Improvements were
seen in postoperative sperm density (P < 0.01), motility (P < 0.002),
and concentration of motile sperm (P < 0.001). Thirty-nine percent of
the assessable patients established pregnancies during the study inter
val (26 of 66). The two treatment groups did not differ significantly
with regard to the likelihood of postoperative improvement in sperm de
nsity (P = 0.64), motility (P = 0.33), concentration of motile sperm (
P = 0.11), or pregnancy rate (P = 0.83). Percutaneous embolization and
surgical ligation of varicocele are equally effective in improving ma
le infertility and cost about the same. Embolization offers the potent
ial advantage of shorter recovery to full activity as compared to surg
ical ligation. Where experienced interventional radiologists are avail
able, percutaneous embolization should be offered as an alternative to
open ligation.