الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
This work was performed for 30 male patients with
testicular varicocele and variable clinical presentations; the
most common was infertility with abnormal spermiogram.
Other complains were painful palpable scrotal varicocele.
Most of our cases were clinically detectable (24 cases).
Six cases were subclinical with suspicious semen analysis.
There was predominance of left sided varicocele (28
cases) and 1 bilateral case.
It was noted that spermatic venography was an ideal most
sensitive test for detecting subclinical varicocele and
confirming detectable ones in addition to vascular mapping and
planning the proper method of treatment.
Venographic findings showed 29 cases with marked
reflux with incompetent or absent valves of the internal
spermatic veins. One case was bilateral due to
intercommunicating channels between both sides.
One case showed competent valve at the termination of
internal spermatic vein and reflux occurred through
incompetent collaterals. This case was not suitable candidate
for embolization.
Immediately after venography, embolization was
performed for 29 cases of reflux and incompetent internal
Summary and Conclusion
spermatic veins. In theses cases of successful embolization we
have used fibered platinum coils (Nester, Cook product).
Percutaneous embolization of the internal spermatic vein
to treat varicocele is a minimally invasive outpatient procedure
that, when performed by experienced interventional
radiologists, has high technical success rates, low recurrence
rates, very low morbidity and minimal radiation, in addition to
significantly improving semen quality in patients and treating
painful varicocele. It has been demonstrated to be equal to
surgical ligation in clinical results and as or more cost effective.
Its minimally invasive nature allows it be well tolerated
with shorter recovery times and less discomfort relative to
surgery. When skilled and experienced vascular and
interventional radiology services are available, embolization is
an effective alternative to surgery and should be offered as such
or as primary therapy for varicocele treatment.
Follow up every 3 months was performed through color
Doppler US, semen analysis in addition to clinical examination.
Recurrence of reflux was detected in a case of left sided
varicocele 12 months after embolization. Improved
spermiograms were noted in all patients after 3-6 months.
In conclusion, we recommended spermatic venography in
patients with clinically detectable varicocele, in subclinical,
suspected ones and also in infertile men with abnormal
spermiograms showing oligoasthenospermia. It is indicated
Summary and Conclusion
before surgical management of varicocele for vascular
mapping, detection of anastomoses of internal spermatic veins
and to determine the appropriate method of management;
surgical or transcatheter embolization. It may be needed also
after surgical management to detect persistent or recurrent
reflux and varicocele.
Varicocele embolization should be the treatment of
choice for testicular varicocele with reflux and incompetent
internal spermatic veins and in post operative recurrent
varicocele.