Embolization outperforms surgery against varicoceles

Image-guided percutaneous sclerotherapy should replace surgery for the treatment of varicoceles, according to a long-term study by Italian researchers. The technique is much less invasive and effectively addresses the pain, infertility, and recurrence linked to the condition. The bad news is that few patients know this treatment exists.

Varicoceles affect about 10% of all men. These varicose veins of the testes and scrotum are painful and may lead to infertility. Open surgical ligation performed by urologists remains the standard of care. Sclerotherapy, the use of a drug that hardens the veins to reduce or block back pressure from blood flow, as well as other embolization procedures have consistently shown better results than surgery. The main problem, however, is that most patients with the condition are seen and treated by urologists, said Dr. Robert L. Worthington-Kirsch, an interventional radiologist at Image Guided Surgery Associates in Philadelphia.

"Urologists only refer patients for embolotherapy if the patient has recurrence or there is some contraindication for surgery," Worthington-Kirsch said.

In this recent study, researchers at the S. Croce Hospital in the town of Cuneo treated 918 male patients with varicoceles between January 1999 and December 2005. Patients, aged nine to 65, underwent fluoroscopy-guided embolization with hydroxypolyethoxydocanol to sclerose, or seal, the faulty veins.

The investigators found sclerotherapy was effective in 98% of these patients, who showed a progressive improvement in sperm count after treatment. Researchers presented their findings at the 2007 Society of Interventional Radiology meeting.

The minimally invasive procedure does not require hospitalization or general anesthesia, and its results match or surpass those of surgery, but with a lower recurrence rate, said principal investigator Dr. Maurizio Grosso, chief of radiology at S. Croce Hospital.

According to Grosso, the St. Anna Hospital in Turin has recommended this procedure for almost a decade. St Anna is one of the most important fertility centers in Italy.

"Hopefully this research will make American men more aware of their treatment options," Grosso said.

According to Worthington-Kirsch, the low referral base in the U.S. for this procedure reveals more than a turf issue. It shows that interventional radiologists don't have a particularly strong public face. Not only patients, but other physicians as well, ignore that interventional radiologists can do it, he said.

"Like so many other things, the issue is one of disseminating information that this is something IRs can do well. It's about getting out and talking to people, building relationships with referring physicians, and building some public awareness that this is an option," he said.

For more information from the Diagnostic Imaging archives:

Sonography reveals the causes of groin pain

Sclerosing foam enhances embolization of varicose veins

Sclerosing agent boosts varicose vein embolization