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Volume 18, Issue 2 (March 2016) 18, 292–295; doi: 10.4103/1008-682X.171658

Antegrade scrotal sclerotherapy of internal spermatic veins for varicocele treatment: technique, complications, and results

Alessandro Crestani, Gianluca Giannarini, Mattia Calandriello, Marta Rossanese, Mariangela Mancini, Giacomo Novara, Vincenzo Ficarra

1Academic Medical Centre Hospital Santa Maria della Misericordia, Udine, Italy; 2Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, Padova,
Italy; 3Department of Experimental and Clinic Medical Sciences, Urology Unit, University of Udine, Udine, Italy.

Correspondence: Prof. V Ficarra (ficarra.vincenzo@aoud.sanita.fvg.it)


Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters.
Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate.
Antegrade scrotal sclerotherapy (ASS) represented one of the main alternatives to the traditional inguinal or suprainguinal surgical
ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and
present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of
treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an
original modified technique with a long follow‑up. Between December 1997 and December 2014, we performed 674 ASS. Mean
operative time was 14 min (range 9 to 50 min). No significant intraoperative complications were reported. Within 90 days from
the procedure, postoperative complications were recorded in overall 49 (7.2%) patients. No major complications were recorded.
A persistent/recurrent varicocele was detected in 40 (5.9%) cases. In 32/40 (80%) cases, patients showed preoperative grade III
varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 × 106 to 21 × 106 ml−1 (P < 0.001).
The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% (P < 0.001). Percentage of
normal forms increased from 17% before surgery to 35% 1 year after the procedure (P < 0.001). In the subgroup of the 168
infertile patients, 52 (31%) fathered offspring at a 12‑month‑minimum follow‑up. Therefore, ASS is an effective minimal invasive
treatment for varicocele with low recurrence/persistence rate

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