DOPPLER SONOGRAPHY OF VARICOCELE - LONG-TERM FOLLOW-UP AFTER VENOGRAPHY AND TRANSCATHETER SCLEROTHERAPY

Sixty-eight patients with unilateral left-sided idiopathic varicocele who had not been treated previously were examined with Doppler sonogra phy before and 1, 3, and 12 months after selective venography with bal loon occlusion and transcatheter sclerotherapy of the internal spermat ic vein. Varicocele and its persistence or recurrence was diagnosed by reflux only. Reflux was differentiated into stop-type and shunt-type by Doppler sonography. The resolution of varicocele was defined by abs ence of any reflux. The rate of resolution was greatest 3 months after sclerotherapy (49 patients, 72%). The diagnosis of persisting or recu rring varicocele at this time does not seem to be justified, however, as in our study both further improvement and deterioration were observ ed up to 12 months after treatment. Twenty patients (29%) had a persis ting or recurring varicocele 12 months after sclerotherapy. Reflux is the parameter of significance for diagnosing varicocele and its persis tence or recurrence after therapy. Improvement of clinical aspects of varicocele (e.g., sperm count, sperm motility, and conception rates) d epends on therapy of even subclinical varicoceles. Therefore, diagnosi s and retreatment of persistent or recurrent varicoceles seems essenti al. The high sensitivity of Doppler sonography permits adequate assess ment of the therapeutic result and evaluation of real rates of persist ent or recurrent varicoceles after venography with balloon occlusion a nd transcatheter sclerotherapy.