The value of percutaneous coil embolization in the treatment of varicocele compared with laparoscopic varicocelectomy: a prospective study

Background
This study was done to evaluate the efficacy, feasibility, safety, and postoperative outcomes of radiological percutaneous embolization compared with laparoscopic technique in the treatment of primary varicocele.
Patients and methods
The authors evaluated 60 patients who presented with clinically and radiologically evident varicoceles proved by testicular duplex studies and experienced infertility or subfertility confirmed by semen analysis together with chronic testicular pain attributed to varicocele. A total of 30 patients (50%) were operated via laparoscopic varicocelectomy (group A) and the other 30 patients were selected for percutaneous varicocele embolization with coiling of the testicular (spermatic) veins (group B).
Results
In all cases, patient complaints, clinical examination, and radiological studies were performed, supported with semen analysis in patients with subfertility. In group A patients, the mean age was 23 years, whereas it was 28 years for the group B patients. The average procedural time was 34 min for the group A patients and 45 min for group B. Of patients in group A, one had a small port site hematoma and two patients had secondary hydrocele formation, whereas 1 of the group B patients had minor puncture site hematoma and 3 patients had transient postcoiling mild pain. Semen analysis improved in 93.3% of the group A patients and 83.3% of the group B patients.
Conclusion
Laparoscopic varicocelectomy is safe and effective, causing minimal discomfort and early return to activity with a low recurrence rate. Percutaneous varicocele embolization is a minimally invasive technique that has a high success rate in experienced hands, has low morbidity with real-time delineation, and can be done under local anesthesia as an outpatient procedure with minimal risk of radiation exposure.