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Shin: Interventional Treatment of Varicocele
Interventional Radiology
Review Article

Journal of the Korean Society of Radiology 2016; 75(3): 163-170.

Published online: 18 August 2016

DOI: https://doi.org/10.3348/jksr.2016.75.3.163

Interventional Treatment of Varicocele

Ji Hoon Shin, MD

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Corresponding author: Ji Hoon Shin, MD. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel. 82-2-3010-4380, Fax. 82-2-476-0090, jhshin@amc.seoul.kr

Received 30 March 2016       Revised 1 May 2016       Accepted 24 May 2016

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Varicocele is a dilatation of the veins in the pampiniform plexus and manifests as mass-effect, pain, testicular atrophy, or male infertility. Traditionally, surgical treatment has been the mainstay of treatment of varicocele, while interventional treatment, which is endovascular embolization of the testicular vein, has been gaining popularity recently. In this review, diagnosis of the disease, indications and procedure details of interventional treatment, results, and complications are discussed.

Keywords: Genital Diseases, Male, Varicocele, Sclerosing Solutions

Figures and Tables

Fig. 1

Ultrasonographic features of a varicocele.

A. On ultrasonographic image, pampiniform plexus of veins is dilated more than 2 mm in diameter.
B. Color Doppler image shows hypervascularity of the dilated pampiniform plexus.
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Fig. 2

Bähren classification of varicocele anatomy (details of each type are described in Table 1).

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Fig. 3

Type III varicocele.

Left renal venogram shows reflux of contrast medium into the testicular vein (arrows) (A). The catheter is inserted from above, through the right basilic vein access. The testicular vein shows duplication (arrows) in its distal part (B). Note the contrast medium reflux into the pampiniform plexus (arrowhead) (B). The distal testicular vein is embolized with coils and treated with sclerotherapy (C); then, the proximal testicular vein is also embolized with coils (D). Left renal venogram shows no further reflux into the testicular vein (D).
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Fig. 4

Type IVb varicocele.

A. Left renal venogram shows reflux of contrast medium into the tortuous collateral vein (arrows). The proximal testicular vein is not seen.
B. The collateral vein (arrows) is connected with the probable testicular vein (arrowheads).
C. The testicular vein (arrows) is refluxed distally below the inguinal canal.
D. The distal testicular vein is embolized with coils and treated with sclerotherapy, followed by coil embolization of the proximal testicular vein.
E. Ultrasonographic image shows a dramatic reduction in the vascularity of the pampiniform plexus six days after sclerotherapy.
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Table 1

Venography of a Left Varicocele (Bähren Classification)

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Type Characteristics
I Reflux into a single incompetent TV
II Reflux into a single TV which communicates with iliac veins, lumbar veins, perivertebral venous plexus or inferior vena cava
III Reflux into a duplicated TV
IV Reflux through renal hilar or capsular veins
IVa: Incompetent valve function
IVb: Competent valve function
V Reflux into a TV that drains into the circumaortic renal vein

TV = testicular vein

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