Varicocele embolization through competent internal spermatic veins.

Transvenous embolization has gained wide acceptance as a primary therapeutic technique in the management of varicocele. In most cases incompetence of the internal spermatic vein is the main cause of the disorder. In 18 of 165 patients treated with embolization, venography demonstrated competence of the internal spermatic vein; the varicocele was due to incompetence of some other anastomotic connection to the vein or the pampiniform plexus. The finding of valvular competence during embolization in a patient with clinical or ultrasonographic evidence of varicocele should not lead to termination of the procedure; instead, a concerted effort should be made to cross the valve to allow therapeutic embolization.