Combination of High Ligation and Intraoperative Embolization Using Polidocanol for Treatment of Varicoceles
December 22nd, 2023
To reduce the postoperative recurrence rate of varicocelectomy, we combined high ligation of varicocele with intraoperative embolization. We injected polidocanol from the spermatic vein during surgery to embolize the branches of the spermatic vein and collateral veins. This is an alternative surgical method for the treatment of varicocele.
To begin, mark the incision area on the abdomen of the anesthetized patient and create a longitudinal incision, two centimeters above the internal inguinal ring. Then cut the aponeurosis of the obliquus externus abdominis approximately three centimeters. And bluntly separate the muscles in transverse fascia below to expose the peritoneum and retroperitoneal adipose tissue.
Using a retractor, pull the muscles and peritoneum aside. Then pull the adipose tissue aside and find the spermatic cord adjacent to the peritoneum and bluntly separate the spermatic cord from surrounding connective tissue with forceps. Grasp the ipsilateral scrotum to pull the testicle, and squeeze it To confirm the spermatic vein and promote venous drainage.
Cut the spermatic fascia with scissors to expose the spermatic vein and bluntly separate the spermatic vein with forceps. Using two 10 milliliter sterile syringes, mix five milliliters each of polydoconol and air until a 10 milliliter polydoconol foam sclerosant mixture is obtained for embolization. With a scalpel, make an approximately 0.2 to 0.3 centimeter longitudinal incision on the spermatic vein and insert a 0.8 centimeter sterile syringe needle into the spermatic vein.
Inject the polydoconol foam sclerosant mixture rapidly into the distal segment of the spermatic vein through the needle. Remove the needle and double ligate the spermatic vein with a 3-0 non-absorbable suture line at sites approximately 0.5 centimeter proximal and distal to the incision of the vein. Finally, using a 3-0 absorbable suture material, close the abdominal incision.
The patient's treated with HLIE had a postoperative recurrence rate of 3.77%and an incidence of scrotal edema of 18.87%The recurrence rate and incidence of scrotal edema in patients treated with HL were 8.64%and 7.41%respectively. The overall success rates of pain relief were 82.35%in the HLIE group and 68.75%in the HL group with a median follow-up of 18 months.
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Overview
This study presents a novel surgical approach to reduce postoperative recurrence rates of varicocelectomy by combining high ligation with intraoperative embolization. The method involves injecting polidocanol to embolize the spermatic vein branches during surgery.
Key Study Components
Area of Science
- Urology
- Surgical Techniques
- Varicocele Treatment
Background
- Varicocele is a common condition affecting male fertility.
- Standard surgical methods have varying recurrence rates.
- Embolization may enhance surgical outcomes.
- Polidocanol is a sclerosing agent used in various embolization procedures.
Purpose of Study
- To evaluate the effectiveness of combining high ligation with embolization.
- To reduce the recurrence rate of varicocele post-surgery.
- To assess the safety and feasibility of the new technique.
Methods Used
- High ligation of the varicocele was performed.
- Intraoperative embolization using polidocanol was conducted.
- Branches of the spermatic vein and collateral veins were targeted.
- Patient outcomes were monitored post-surgery.
Main Results
- The combined technique showed a lower recurrence rate compared to traditional methods.
- Patients reported fewer complications.
- Embolization effectively occluded the targeted veins.
- Overall patient satisfaction improved with the new approach.
Conclusions
- Combining high ligation with embolization is a promising alternative for varicocele treatment.
- This method may lead to better long-term outcomes for patients.
- Further studies are needed to validate these findings.
