Paediatric Varicocele Embolisation: Clinical Experience, Insights and Long Term Clinical Outcomes Over 14 Years at a Tertiary Centre-A Cohort Study.

Abstract

Introduction: Varicocele is a correctable cause of male infertility with management options including catheter embolisation of the testicular vein, done by Interventional Radiologists. Varicoceles can present in childhood and adolescence with scrotal pain or discomfort, or may be subclinical. It involves dilatation of the pampiniform plexus related to congestion and retrograde flow in the testicular vein. If left untreated, the pain and discomfort may impact the quality of life of the paediatric patient, and in the long term, infertility may ensue. However, limited data are available on the long-term clinical outcomes and complications of Varicocele embolisation in paediatric patients.

Method: Retrospective cohort study of 14 years of endovascular Varicocele embolisation at a single-operator tertiary paediatric centre.

Results: Eighty-four patients with a median age of 14 years (range 8-17 years) were identified. The varicoceles were predominantly of grade 1 or 2. 99% of patients had unilateral left-sided varicoceles. One patient had bilateral varicoceles. This study demonstrated that the technical success rate of endovascular embolisation is 94% and the clinical success rate is 98%. 84% reported feeling well in the immediate postprocedural period. 86% of cases reported excellent long-term progress. A small proportion (10%) experienced long-term discomfort or pain. There were no cases of relapse.

Conclusion: Endovascular embolisation is a successful technique for the management of Varicocele in paediatric patients, with good immediate and long-term clinical outcomes. It has low recurrence rates.