Percutaneous transfemoral testicular vein embolisation in the treatment of childhood varicocoele.

摘要

BACKGROUND: Controversy surrounds the early treatment of childhood varicocoele and its role in the prevention of testicular atrophy and male infertility. Various techniques exist, all with varying degrees of success. OBJECTIVES: To show that percutaneous transfemoral testicular vein embolisation is an effective alternative when compared to the conventional open surgical approach. MATERIALS AND METHODS: A retrospective review examining 48 boys (aged 9-18 years; mean 13.2 years) who were treated with transcatheter testicular vein embolisation between 1985 and 1999. Follow-up took the form of out-patient clinical assessment and a telephone questionnaire. Patients were graded as 'good', 'moderate' or 'poor', according to various criteria. RESULTS: Of the 48 patients, 43 (90%) had satisfactory embolisations. Thirty-eight (88 %) had a 'good' clinical outcome at follow-up. There were five technical failures due to a combination of abnormal venous anatomy and severe venospasm. CONCLUSIONS: We believe that where the expertise necessary for testicular embolisation is available, it should be offered as the intervention of first choice. Surgery should be reserved for the rare cases where embolisation is not possible or when recurrence has occurred.