CLINICAL OUTCOME AND COST COMPARISON OF PERCUTANEOUS EMBOLIZATION ANDSURGICAL LIGATION OF VARICOCELE

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.