Treatment Options Nonoperative Therapy

Varicoceles can currently be treated by both operative and nonoperative techniques. Nonoperative treatment is typically performed by interventional radiology and includes transvenous embolization with coils or balloons or injection of sclerosing agents (boiling-hot contrast or absolute ethanol) to induce varix thrombosis. Both embolization and sclerosis are performed under local anesthesia with supplementary intravenous sedation at a cost of one-fourth to one-fifth that of surgery (25). Rates of success vary but generally do not approach those reported for operative varix liga-tion especially with right-sided varicoceles (24,25).

Other nonoperative treatments have not gained acceptance due to equivocal outcomes. Attempts to decrease testicular temperature by means of a scrotal cooling were cumbersome and lacking in durable improvements in semen analysis (12). Empiric medical therapy (clomiphen citrate, tamoxifen) showed no benefit (26).

Laproscopic varicocelectomy is contraindicated in patients with recurrent or persistent with recurrent or persistent varix following a retroperitonealvarix ligation.

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