Doppler sonography of varicocele: long-term follow-up after venography and transcatheter sclerotherapy.

Sixty-eight patients with unilateral left-sided idiopathic varicocele who had not been treated previously were examined with Doppler sonography before and 1, 3, and 12 months after selective venography with balloon occlusion and transcatheter sclerotherapy of the internal spermatic vein. Varicocele and its persistence or recurrence was diagnosed by reflux only. Reflux was differentiated into stop-type and shunt-type by Doppler sonography. The resolution of varicocele was defined by absence of any reflux. The rate of resolution was greatest 3 months after sclerotherapy (49 patients, 72%). The diagnosis of persisting or recurring varicocele at this time does not seem to be justified, however, as in our study both further improvement and deterioration were observed up to 12 months after treatment. Twenty patients (29%) had a persisting or recurring varicocele 12 months after sclerotherapy. Reflux is the parameter of significance for diagnosing varicocele and its persistence or recurrence after therapy. Improvement of clinical aspects of varicocele (e.g., sperm count, sperm motility, and conception rates) depends on therapy of even subclinical varicoceles. Therefore, diagnosis and retreatment of persistent or recurrent varicoceles seems essential. The high sensitivity of Doppler sonography permits adequate assessment of the therapeutic result and evaluation of real rates of persistent or recurrent varicoceles after venography with balloon occlusion and transcatheter sclerotherapy.