Retrograde embolisation of varicocele in the paediatric age group: a review of 10 years' practice.

OBJECTIVE: To review the 10 years' practice of retrograde embolisation of varicoceles in the paediatric age group. PATIENTS AND METHODS: 40 boys (age range, 6-16 years), with varicocele diagnosed both clinically and sonographically, were referred to the radiology department for embolisation. Data of these patients were collected and analysed retrospectively. Patients' age, side, treatment, complications, and outcome were noted. The follow-up ranges from 2 months to 6 years (mean, 1.1 years).
RESULTS: In 24 patients (60%), embolisation was successful at the first attempt and 11 procedures (27.5%) were technical failures; 4 patients (10%) after venography were considered non-embolisable. One patient (2.5%) is yet to be seen in the clinic. Recurrence occurred in 4 patients (10%) of whom 3 had successful repeat embolisation. One patient with a recurrent varicocele did not wish further treatment. Out of the 11 failures, 5 underwent repeat embolisation with success in 3 patients and failure in two. Four patients had successful surgical ligation and 2 patients were treated conservatively. All who were non-embolisable were treated successfully by surgery. Our overall success rate was 65% (n = 26).
CONCLUSIONS: These results suggest that embolisation is valuable as a first line of treatment for paediatric varicoceles provided a skilled interventional radiologist is available. This procedure is less invasive, avoids general anaesthetic, involves minimal postoperative pain, and allows an earlier return to normal activities. However, 35% of patients did eventually require conventional surgery for primary failure of embolisation or late recurrence.