10-year experience of Paediatric varicocele embolization in a tertiary centre with long-term follow-up

Published:December 28, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.12.013



      Paediatric varicocele embolization has many benefits over surgical ligation, but lacks published long-term data. We investigated technical and clinical outcomes in this under reported patient group.


      To evaluate technical success, complications and recurrence rates following varicocele embolization in paediatric patients.

      Materials and methods

      A single-centre retrospective review of procedural data and electronic notes of consecutive patients referred for varicocele embolization over a 10-year period was performed (February 2010–March 2020). The primary outcomes were technical success and clinical efficacy (lack of symptom recurrence). Secondary outcomes included complications, testicular vein size reduction and procedural parameters including radiation exposure. Chi-square analysis was used to identify predictors of clinical success. Follow-up involved outpatient clinical assessment and telephone interview.


      40 patients (median age 15) were referred for left-sided symptomatic varicocele. Technical embolization success was achieved in 36/40 patients (90%), with 4 procedures abandoned (inaccessible vein). Embolization technique was platinum-based coils ± sclerosant. There were no immediate or long-term procedural complications.
      32/36 patients completed short term follow-up at a median interval of 2.8 months. 30/32 (93.78%) experienced early clinical success. We found a significant reduction in peritesticular vein size following embolization (pre-3.70 vs post-2.56 mm, p = 0.00017) and a significant relationship between varicocele grade and early clinical success (χ2 = 4.2, p = 0.04), but not pre-treatment peritesticular vein size (χ2 = 0.02, p = 0.88). 33/36 patients completed long-term follow-up (median 4.2 years, range 0.36–9.9 years) producing a late clinical success rate of 93.9% (31/33). No post procedural complications including hydroceles were identified.


      This study demonstrates technical success, matching rates described in adult patients which is reassuring and in support of embolization in the younger patient cohort. More importantly, the overall clinical success rate is comparable with previous embolization studies. Reassuringly, all symptom recurrences occurred early in follow-up, and there is a cogent argument for a single follow-up appointment at this juncture. Our long-term average follow-up duration, primarily gained via telephone interview, exceeds other studies. Although our study has the longest follow-up for varicocele embolization in children, it is limited by a few patients being lost to early and long-term follow-up. This is a recognised issue faced by studies attempting to follow-up benign conditions with a high clinical success rate.


      Summary TableStudy outcomes with average follow-up length.
      N Average age, range Technical success Clinical success Recurrence Complications Average follow-up length, range
      40 15 (mean), 12-17 90% (36) 94% (31) 3% (1) 0 4.2 years (median), 0.4–9.9 years


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        • European Association Urology
        European association of urology guidelines.
        in: Presented at the EAU annual congress amsterdam 2020. European Association of Urology Guidelines Office, Arnhem, The Netherlands2020 (2020)
        • Locke J.A.
        • Noparast M.
        • Afshar K.
        Treatment of varicocele in children and adolescents: a systematic review and meta-analysis of randomized controlled trials.
        J Pediatr Urol. 2017; 13: 437-445https://doi.org/10.1016/j.jpurol.2017.07.008
        • Akbay E.
        • Çayan S.
        • Doruk E.
        • Duce M.N.
        • Bozlu M.
        The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents.
        BJU Int. 2000; 86: 490-493https://doi.org/10.1046/j.1464-410X.2000.00735.x
        • Baek M.
        • Park S.W.
        • Moon K.H.
        • Chang Y.S.
        • Jeong H.J.
        • Lee S.W.
        • et al.
        Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: a population based study: varicocele in Korean adolescents.
        Int J Urol. 2011; 18: 55-60https://doi.org/10.1111/j.1442-2042.2010.02662.x
        • Niedzielski J.
        • Paduch D.
        • Raczynski P.
        Assessment of adolescent varicocele.
        Pediatr Surg Int. 1997; 12: 410-413https://doi.org/10.1007/BF01076952
        • Cannarella R.
        • Calogero A.E.
        • Condorelli R.A.
        • Giacone F.
        • Aversa A.
        • La Vignera S.
        Management and treatment of varicocele in children and adolescents: an endocrinologic perspective.
        J Clin Med. 2019; 8: 1410https://doi.org/10.3390/jcm8091410
        • Cassidy D.
        • Jarvi K.
        • Grober E.
        • Lo K.
        Varicocele surgery or embolization: which is better?.
        Can Urol Assoc J J Assoc Urol Can. 2012; 6: 266-268https://doi.org/10.5489/cuaj.11064
        • Storm D.W.
        • Hogan M.J.
        • Jayanthi V.R.
        Initial experience with percutaneous selective embolization: a truly minimally invasive treatment of the adolescent varicocele with no risk of hydrocele development.
        J Pediatr Urol. 2010; 6: 567-571https://doi.org/10.1016/j.jpurol.2010.01.003
        • Austoni E.
        • Cazzaniga A.
        • Gatti G.
        • Baroni P.
        • Gentilini O.
        • Levorato C.A.
        [Varicocele and its repercussion on infertility. Indications and limitations of surgical intervention].
        Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 1998; 70: 103-107
        • Vañó E.
        • Miller D.L.
        • Martin C.J.
        • Rehani M.M.
        • Kang K.
        • Rosenstein M.
        • et al.
        ICRP publication 135: diagnostic reference levels in medical imaging.
        Ann ICRP. 2017; 46: 1-144https://doi.org/10.1177/0146645317717209
        • Dubin L.
        • Amelar R.D.
        Varicocele size and results of varicocelectomy in selected subfertile men with varicocele∗.
        Fertil Steril. 1970; 21: 606-609https://doi.org/10.1016/S0015-0282(16)37684-1
        • Dindo D.
        • Demartines N.
        • Clavien P.-A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213https://doi.org/10.1097/01.sla.0000133083.54934.ae
        • Nabi G.
        • Asterlings S.
        • Greene D.R.
        • Marsh R.L.
        Percutaneous embolization of varicoceles: outcomes and correlation of semen improvement with pregnancy.
        Urology. 2004; 63: 359-363https://doi.org/10.1016/j.urology.2003.09.026
        • Zampieri N.
        • Chironi C.
        • Sulpasso M.
        Treatment of varicocele with transfemoral retrograde sclero-embolization in pediatric patients under local anesthesia.
        Minerva Pediatr. 2015; 67: 227-229
        • Fayad F.
        • Sellier N.
        • Chabaud M.
        • Kazandjian V.
        • Larroquet M.
        • Raquillet C.
        • et al.
        Percutaneous retrograde endovascular occlusion for pediatric varicocele.
        J Pediatr Surg. 2011; 46: 525-529https://doi.org/10.1016/j.jpedsurg.2010.08.014
        • Malekzadeh S.
        • Fraga-Silva R.A.
        • Morère P.-H.
        • Sorega A.
        • Produit S.
        • Stergiopulos N.
        • et al.
        Varicocele percutaneous embolization outcomes in a pediatric group: 7-year retrospective study.
        Int Urol Nephrol. 2016; 48: 1395-1399https://doi.org/10.1007/s11255-016-1340-x
        • Li X.
        • Samei E.
        • Segars W.P.
        • Sturgeon G.M.
        • Colsher J.G.
        • Toncheva G.
        • et al.
        Patient-specific radiation dose and cancer risk estimation in CT: part II. Application to patients.
        Med Phys. 2011; 38: 408-419https://doi.org/10.1118/1.3515864