Sonographic Findings and Clinical Outcomes After Embolization of Symptomatic Varicoceles

Purpose: To characterize symptomatic outcomes and scrotal ultrasound findings after varicocele embolization in men with chronic groin pain

Materials and Methods:

A retrospective review was conducted of scrotal ultrasounds after technically successful varicocele embolization for chronic groin pain  between Jan 2000 and July 2022.  All were performed after standing for 15 minutes with grey scale and color duplex.  



Results:

432 males with chronic groin pain and varicoceles, aged 13 – 63,  were treated.   45 (10.4%) had coincidental infertility.  Bilateral varicoceles were seen in 183 (42.4%), pain was bilateral in 71.  Follow up ultrasound was performed 3 – 14 months post procedure in 360 patients,  72 (16.7%) did not return.    

 

Of 360 men with ultrasound followup, 291 (80.8%)  were symptomatically  improved, 12 (3.3%) completely.  In 272/ 291 (93.5%) with symptom improvement the largest  pampiniform plexus vein was smaller than pre-treatment but still dilated (1.5 -5.4 mm, mean 2.4) with normal or no blood flow accentuation with Valsalva, 18 (6.2%) had normal ultrasound, (no dilated veins, normal or no Valsalva accentuation), and 1 (0.3%) had improved symptoms but sonographically persistent varicocele. 

 

Of 69 men with no symptom improvement 27 / 69 (39.1%) had persistent varicocele;  42/69  (60.9%) had veins smaller than pre-treatment and normal or no blood flow accentuation with Valsalva, 11 / 42 had findings of  chronic epididymitis (persistent from pre-treatment), 31/42  no other findings.   



Conclusion: 81% of men with chronic groin pain had symptomatic improvement after varicocele embolization.  The most common clinical outcome is less frequent, less severe pain rather than cure.  Persistent dilation of  scrotal veins, sometimes marked, is common after successful embolization, Loss of abnormal accentuation of venous flow with Valsalva correlates more closely with successful treatment.