Varicocele treatment - outcomes of ligation and embolisation in the treatment of 281 men with a clinically palpable varicocele

Treatment options for varicoceles include surgical ligation (SL) and radiological embolisation (RE). RE has the advantages of being performed under LA. The EAU guidelines quote the recurrence rate with RE of 3.8-10%, hence SL is often performed despite the potential for increased morbidity. Our objective was to compare the outcomes of SL and RE with respect to improvement in semen analyses and sonographic findings. This was a retrospective study investigating men who had varicocele treatment from 2017-2020. We assessed their pre-and post-treatment SA and ultrasound. The results were analysed using Wilcoxon, Mann-Whitney and t-test. 281 patients were treated; 168 with RE, 113 with SL. 124 had pre-and post-treatment SA (RE n=78, SL n=46). Both groups showed statistically significant improvement in count; RE 63% (p=<0.001), SL 52% (p=0.009) and Morphology; RE 45% (p=0.003), SL 46% (p=0.005). Neither group showed a statistically significant improvement in Motility; RE 47% (p=0.156), SL 46% (p=0.032). There was no statistically significant difference between the two groups. 83 patients had a pre-and post-treatment US performed (RE n=56; SL n=27). Vein diameter decreased in 68% following RE (3.7±0.86 mm to 3.1±0.80 mm, p<0.0001), 84% following SL (3.91±1.0 mm to 3.1±0.72 mm, p=0.001). Doppler US demonstrated cessation of reflux in 56% treated by RE (n=32) and 52% following SL (n=23). Technical failure for embolization included 11 single sided failures and 1 bilateral. Neither RE and SL are superior for improving semen analysis parameters. Vein diameter decreases significantly after both. RE is a LA, day case procedure versus a GA and groin incision. We would favour the less invasive technique in the light of these findings. n/a