Percutaneous transfemoral testicular vein embolisation in the treatment ofchildhood varicocoele

Background. Controversy surrounds the early treatment of childhood varicoco ele and its role in the prevention of testicular atrophy and male infertili ty. Various techniques exist, all with varying degrees of success. Objectives. To show that percutaneous transfemoral testicular vein embolisa tion is an effective alternative when compared to the conventional open sur gical approach. Materials and Methods. A retrospective review examining 48 boys (aged 9-18 years; mean 13.2 years) who were treated with transcatheter testicular vein embolisation between 1985 and 1999. Follow-up took the form of out-patient clinical assessment and a telephone questionnaire. Patients were graded as 'good', 'moderate' or 'poor', according to various criteria. Results. Of the 48 patients, 43 (90 %) had satisfactory embolisations. Thir ty-eight (88 %) had a 'good' clinical outcome at follow-up. There were five technical failures due to a combination of abnormal venous anatomy and sev ere venospasm. Conclusions. We believe that where the expertise necessary for testicular e mbolisation is available, it should be offered as the intervention of first choice. Surgery should be reserved for the rare cases where embolisation i s not possible or when recurrence has occurred.