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• W2047381983 abstract "No AccessJournal of UrologyAdult Urology1 May 2008Surgical Outcomes After Modified Antegrade Scrotal Sclerotherapy: A Prospective Analysis of 700 Consecutive Patients With Idiopathic Varicocele Antonio Galfano, Giacomo Novara, Massimo Iafrate, Simonetta Fracalanza, Giovanni Novella, Stefano Cavalleri, Walter Artibani, and Vincenzo Ficarra Antonio GalfanoAntonio Galfano Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author , Giacomo NovaraGiacomo Novara Istituti di Ricovero e Cura a Carattere Scientifico, Istituto Oncologico Veneto, University of Padua, Padua, Italy More articles by this author , Massimo IafrateMassimo Iafrate Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author , Simonetta FracalanzaSimonetta Fracalanza Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author , Giovanni NovellaGiovanni Novella Department of Urology, University of Verona, Verona, Italy More articles by this author , Stefano CavalleriStefano Cavalleri Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author , Walter ArtibaniWalter Artibani Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author , and Vincenzo FicarraVincenzo Ficarra Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.01.042AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We analyzed the surgical outcomes of antegrade scrotal sclerotherapy in a large, prospective, multisurgeon, consecutive series of patients treated for idiopathic varicocele. Materials and Methods: We prospectively collected data on 697 consecutive patients undergoing antegrade scrotal sclerotherapy between 1997 and 2005. For every patient we evaluated age, side, clinical and Doppler ultrasound grade, and seminal impairment. Perioperative complications were evaluated 1 month after surgery. At 12 months after antegrade scrotal sclerotherapy all patients underwent Doppler ultrasound. In those with seminal impairment semen analysis was also performed. Failure was defined as at least Doppler grade 1 varicocele. Results: Median age of the 697 analyzed patients was 28 years. Mean surgical time was 15 minutes. All surgeries were performed using local anesthesia and no intraoperative complications were observed. All patients were discharged home within 4 hours. Postoperatively complications developed in 35 patients (5%) and failure occurred in 63 (9%). Persistent reflux was observed in 6.5% of adolescents, in 9.4% of adults and in 7.5% of patients with recurrent varicocele. Failure rates were similar for different grades and sides. The failure rate was significantly higher in patients treated by surgeons during the learning curve (p = 0.007). In the 414 patients with seminal impairment median sperm count and the median percent of progressive motility and normal forms significantly improved after surgery (p <0.001). Conclusions: Considering the low persistence and complication rates in all patient categories (adolescents, adults, first diagnosis, and bilateral and recurrent disease) antegrade scrotal sclerotherapy can be proposed as a safe and efficacious first choice treatment for varicocele. A specific learning curve is required to achieve the best outcome. References 1 : A Doppler-based study on the prevalence of varicocele in German children and adolescents. Andrologia2006; 38: 13. Google Scholar 2 : EAU Guidelines on Male Infertility. http://www.uroweb.org. Accessed July 30, 2007. Google Scholar 3 Report on varicocele and infertility: Practice Committee of the American Society for Reproductive Medicine. Fertil Steril2006; 86: S93. Google Scholar 4 : Treatment of varicocele in subfertile men: The Cochrane Review—a contrary opinion. Eur Urol2006; 49: 258. Google Scholar 5 : Antegrade scrotal sclerotherapy for the treatment of varicocele: technique and late results. J Urol1994; 151: 386. Link, Google Scholar 6 : Treatment of varicocele: a prospective randomized comparison of laparoscopy versus antegrade sclerotherapy. Eur Urol2002; 41: 398. Google Scholar 7 : Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study. BJU Int2002; 89: 264. Google Scholar 8 : Treatment of varicocele: randomized prospective study on open surgery versus Tauber antegrade sclerotherapy. J Androl2005; 26: 328. Google Scholar 9 : Treatment of varicocele with reference to age: a retrospective comparison of three minimally invasive procedures. Surg Endosc2007; 21: 61. Google Scholar 10 : Varicocelectomy: 986 cases in a twelve-year study. Urology1977; 10: 446. Google Scholar 11 WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction: World Health Organization. Cambridge, United Kingdom: Cambridge University Press1999. Google Scholar 12 : Modified antegrade scrotal sclerotherapy in adolescent patients with varicocele. J Pediatr Surg2004; 39: 1034. Google Scholar 13 : Recurrent varicocele: role of antegrade sclerotherapy as first choice treatment. Eur Urol2002; 41: 614. Google Scholar 14 : Adolescent varicocele: Tauber antegrade sclerotherapy versus Palomo repair. J Urol2001; 166: 1462. Link, Google Scholar 15 : Treatment of varicoceles in childhood and adolescence with Tauber’s antegrade scrotal sclerotherapy. J Pediatr Surg2000; 35: 1222. Google Scholar 16 : Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence. Br J Urol1995; 76: 21. Google Scholar 17 : Antegrade scrotal sclerotherapy for treating primary varicocele in children. BJU Int2006; 97: 809. Google Scholar 18 : Microsurgical management of male infertility. Nat Clin Pract Urol2006; 3: 381. Google Scholar 19 : Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol1992; 148: 1808. Link, Google Scholar 20 : Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology2007; 69: 417. Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 5May 2008Page: 1933-1937 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordssclerotherapypostoperative complicationsvaricoceleinfertilitymalescrotumAcknowledgmentsIn memory of Malcolm Garfield, who passed away in August 2007. This article was his last translation.MetricsAuthor Information Antonio Galfano Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author Giacomo Novara Istituti di Ricovero e Cura a Carattere Scientifico, Istituto Oncologico Veneto, University of Padua, Padua, Italy More articles by this author Massimo Iafrate Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author Simonetta Fracalanza Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author Giovanni Novella Department of Urology, University of Verona, Verona, Italy More articles by this author Stefano Cavalleri Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author Walter Artibani Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author Vincenzo Ficarra Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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