Evolution in varicocele sclerosing treatment: The ante/retrograde (A/R) approach

Objective: To evaluate diagnostic and therapeutic efficacy of simultaneous ante/retrograde (A/R), trans-scrotal and trans-brachial approach in sclerotherapy of varicocele. Materials and Methods: Between June 2000 and June 2002, 99 patients with varicocele were submitted to simultaneous A/R sclerotherapy of internal spermatic venous plexus. All presented grade III left varicocele, 39 also had right varicocele. Recurrent left varicocele was present in 25 following surgical ligations, in 1 following retrograde sclerosis, in 3 following both surgical and sclerosing techniques. Simultaneous A/R approach was performed using transbrachial percutaneous access for retrograde catheterization which does not obstruct trans-scrotal surgical field. The procedure is performed without need for general anaesthesia. Results: Sclerotherapy of spermatic veins was always completed. At minimum 12 months follow-up (mean 18 months), only 1 failure was observed. Conclusion: Trans-scrotal access allowed to guide, by means of antegrade venography, retrograde selective cannulation of spermatic vein. A/R procedure allows a complete diagnostic evaluation of collateral circulation, with possibility to occlude all vessels draining varicocele. Results at long-term follow-up show very low incidence of recurrence.