Spermatic vein embolization as a treatment for symptomatic varicocele

• Published in: Canadian Urological Association journal Vol. 15; no. 11; pp. E569 - E573
• Main Authors: Broe, Mark P, Ryan, James P C, Ryan, Eanna J, Murphy, David J, Mulvin, David W, Cantwell, Colin, Brophy, David P
• Format: Journal Article
• Language: English
• Published: Canada Canadian Urological Association 01.11.2021; Canadian Medical Association
• Subjects: Care and treatment; Original Research; Pain; Patient outcomes; Therapeutic embolization; Varicocele; Canada
• ISSN: 1911-6470; 1920-1214
• DOI: 10.5489/cuaj.7077

Varicocele is a relatively common condition in men that causes pain in approximately 10% of cases. There have been few studies to date assessing the improvements in both pain and quality of life parameters associated with spermatic vein embolization (SVE) as a treatment for patients with symptomatic varicocele, so we aimed to assess this. A review was carried out of consecutive SVE procedures performed at our institution from 2013-2019. Only patients with painful varicocele were included after other causes of testicular pain were excluded. The technique employed was a combination of distal coil embolization of the spermatic vein with 4-6 mm coils at the level of the inguinal canal, as well as sclerotherapy to prevent reflux of sclerosant. Furthermore, a prospective validated Pain Impact Questionnaire-6 (PIQ-6) was performed to assess for improvement in quality of life. A matched pair Student two-tailed t-test was used to compare mean scores pre- and post-treatment, with 95% confidence intervals presented as T scores and their associated p-values. Over six years, 62 SVE procedures were performed for symptomatic varicocele. Success rate was 95%, with a median follow up of nine months. Two patients had a failed procedure on two occasions requiring subsequent surgical ligation. There was one clinically significant recurrence. All components of PIQ-6 score showed a statistically significant reduction post-SVE, most noticeably pain severity and impact on leisure activities. SVE is a safe, effective, and well-tolerated treatment for symptomatic varicocele, improving pain and quality of life.