EVALUATION OF MICROSURGICAL VARICOCELE CATHETER EMBOLIZATION VERSUS VARICOCELECTOMY

Abstract

A varicocele is an abnormal dilation of the pampiniform plexus of the testicular veins, which drain the testicle. It can be treated surgically or by percutaneous catheter embolization. It is essential that the radiation risks associated with the procedure are minimized. The objectives of this study are to: Evaluate the value of the varicocele catheter embolization versus the microsurgical varicocelectomy impacted on semen analysis, evaluate the feasibility of the methods of treatment of varicocele, estimate the radiation risks in the varicocele catheter embolization and finally optimize the radiation dose to patients during the varicocele catheter embolization procedures. A total of one hundred and nineteen patients aged (mean age 35.56 years) referred to the division of andrology, were diagnosed with varicocele. Patients were divided into two groups according to the method of treatment: Group (A) 66 patients treated by varicocele catheter embolization (15 prospective and 51 retrospective) and group (B) 53 patients treated by microsurgical varicocelectomy. Infertility was the indication for treatment in both groups. Semen analysis was performed for both groups three times before treatment and at least three times after treatment, with 3-days abstinence from sexual intercourse before semen collection. A minimum interval between all the analyses was 2 weeks. The success rate, recurrence rate and complication were recorded for group (A) and group (B). Radiation doses were recorded prospectively and retrospectively for group (A). Dose area product DAP during varicocele embolization were measured; these results were then used to estimate the effective dose which used to estimate the fatal cancer risk. In Group (A) a 15 consecutive patients attending for varicocele embolization were optimized prospectively by reducing fluoroscopy time, tube current, beam collimation, number of images in fluorography and number of exposures in radiography. The mean value of the total DAP during fluoroscopy, effective dose, estimated fatal cancer were (18.32 Gy.m2 and 29.79 Gy.m2), (5.32 mSv and 8.64 mSv) and (292.4×10-6 and 478.1×10-6) for the prospective and retrospective series respectively. The mean value of X-ray tube voltage for fluoroscopy, mean value of X-ray tube voltage for radiography, mean value of tube current for fluoroscopy and mean value of tube current for radiography were (78.5 kV and 75.4 kV), (75.8 kV and 76.14 kV), (4.7 mA and 5.3 mA) and (545 mA and 556.05 mA) for prospective and retrospective series respectively. Correction of varicocele improves semen quality regardless the method of treatment. Varicocele embolization may be the preferred approach compared with surgery in men with unilateral left-sided varicoceles as this approach offers many benefits in terms of patient safety, morbidity, high success rate with low recurrence rate, effective, minimally invasive and economically viable technique that can be performed on an outpatient basis. Due to radiation protection, this procedure should be performed using fluoroscopy only and limiting exposure time. With careful attention to the technique, substantial reduction in radiation dose can be achieved.