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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. |