J Korean Soc Radiol.  2016 Sep;75(3):163-170. 10.3348/jksr.2016.75.3.163.

Interventional Treatment of Varicocele

• Shin JH

• KMID: 2349320
• DOI: http://doi.org/10.3348/jksr.2016.75.3.163

Abstract

Varicocele is a dilatation of the veins in the pampiniform plexus and manifests as mass-effect, pain, testicular atrophy, or male infertility. Traditionally, surgical treatment has been the mainstay of treatment of varicocele, while interventional treatment, which is endovascular embolization of the testicular vein, has been gaining popularity recently. In this review, diagnosis of the disease, indications and procedure details of interventional treatment, results, and complications are discussed.

MeSH Terms

Atrophy
Diagnosis
Dilatation
Genital Diseases, Male
Infertility, Male
Male
Sclerosing Solutions
Varicocele*
Veins
Sclerosing Solutions

Figure

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  Fig. 1 Ultrasonographic features of a varicocele. A. On ultrasonographic image, pampiniform plexus of veins is dilated more than 2 mm in diameter. B. Color Doppler image shows hypervascularity of the dilated pampiniform plexus.

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  Fig. 2 Bähren classification of varicocele anatomy (details of each type are described in Table 1).

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  Fig. 3 Type III varicocele. Left renal venogram shows reflux of contrast medium into the testicular vein (arrows) (A). The catheter is inserted from above, through the right basilic vein access. The testicular vein shows duplication (arrows) in its distal part (B). Note the contrast medium reflux into the pampiniform plexus (arrowhead) (B). The distal testicular vein is embolized with coils and treated with sclerotherapy (C); then, the proximal testicular vein is also embolized with coils (D). Left renal venogram shows no further reflux into the testicular vein (D).

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  Fig. 4 Type IVb varicocele. A. Left renal venogram shows reflux of contrast medium into the tortuous collateral vein (arrows). The proximal testicular vein is not seen. B. The collateral vein (arrows) is connected with the probable testicular vein (arrowheads). C. The testicular vein (arrows) is refluxed distally below the inguinal canal. D. The distal testicular vein is embolized with coils and treated with sclerotherapy, followed by coil embolization of the proximal testicular vein. E. Ultrasonographic image shows a dramatic reduction in the vascularity of the pampiniform plexus six days after sclerotherapy.

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