Initial Experience with 3% Sodium Tetradecyl Sulfate Foam and Fibered Coils for Management of Adolescent Varicocele
Received 10 January 2007; received in revised form 18 August 2007; accepted 19 August 2007.
Purpose
To report the results of treatment of adolescent patients with varicocele with use of 3% sodium tetradecyl sulfate foam (STS) in combination with pushable fibered coils.
Materials and Methods
From September 2004 to September 2006, 16 adolescent patients (age 12–19 y) with symptomatic varicocele, testicular atrophy, or surgical recurrence underwent embolization with STS foam and coils. The left internal spermatic vein (ISV) was coaxially catheterized from the right femoral vein. Three percent STS foam was placed distally in the ISV during compression so minimal foam entered the pampiniform plexus. A second nest of coils was placed in the ISV at a position over the sacroiliac (SI) joint that occluded most of the parallel collateral vessels. Coils were not placed above the SI joint in most instances. Additional foam was injected in the ISV at the upper level of the SI joint. The upper ISV was left unoccluded. Our standard follow-up consisting of ultrasound and/or physical examination after varicocele occlusion was performed 2–12 months after the procedure.
Results
All occlusions were technically successful, and 15 of 16 patients (94%) exhibited proven disappearance of the varicocele. All patients were asymptomatic except one who had pain despite disappearance of the varicocele. One patient with a bleeding disorder had 48 hours of scrotal discomfort as a result of pampiniform phlebitis caused by the deliberate passage of foam into the pampiniform plexus.
Conclusions
The use of 3% STS foam in combination with pushable fibered coils is a safe and effective sclerosing procedure for adolescent subjects with varicocele.
aDepartment of Diagnostic Radiology, Section of Interventional Radiology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520
bDepartment of Surgery, Section of Urology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520.
Address correspondence to K.J.H.
From the SIR 2006 Annual Meeting.
None of the authors have identified a conflict of interest.
1 K.J.H. and R.I.W. were supported in part by the Josephine Lawrence Hopkins Foundation.
ABSTRACT