Galfano Antonio, Novara Giacomo, Iafrate Massimo, Fracalanza Simonetta, Novella Giovanni, Cavalleri Stefano, Artibani Walter, Ficarra Vincenzo
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
J Urol. 2008 May;179(5):1933-7. doi: 10.1016/j.juro.2008.01.042. Epub 2008 Mar 18.
We analyzed the surgical outcomes of antegrade scrotal sclerotherapy in a large, prospective, multisurgeon, consecutive series of patients treated for idiopathic varicocele.
We prospectively collected data on 697 consecutive patients undergoing antegrade scrotal sclerotherapy between 1997 and 2005. For every patient we evaluated age, side, clinical and Doppler ultrasound grade, and seminal impairment. Perioperative complications were evaluated 1 month after surgery. At 12 months after antegrade scrotal sclerotherapy all patients underwent Doppler ultrasound. In those with seminal impairment semen analysis was also performed. Failure was defined as at least Doppler grade 1 varicocele.
Median age of the 697 analyzed patients was 28 years. Mean surgical time was 15 minutes. All surgeries were performed using local anesthesia and no intraoperative complications were observed. All patients were discharged home within 4 hours. Postoperatively complications developed in 35 patients (5%) and failure occurred in 63 (9%). Persistent reflux was observed in 6.5% of adolescents, in 9.4% of adults and in 7.5% of patients with recurrent varicocele. Failure rates were similar for different grades and sides. The failure rate was significantly higher in patients treated by surgeons during the learning curve (p = 0.007). In the 414 patients with seminal impairment median sperm count and the median percent of progressive motility and normal forms significantly improved after surgery (p <0.001).
Considering the low persistence and complication rates in all patient categories (adolescents, adults, first diagnosis, and bilateral and recurrent disease) antegrade scrotal sclerotherapy can be proposed as a safe and efficacious first choice treatment for varicocele. A specific learning curve is required to achieve the best outcome.
我们分析了在一个大型、前瞻性、多外科医生参与的连续系列特发性精索静脉曲张患者中，顺行阴囊硬化疗法的手术效果。
我们前瞻性收集了1997年至2005年间697例接受顺行阴囊硬化疗法的连续患者的数据。对每位患者，我们评估了年龄、患侧、临床及多普勒超声分级以及精液损害情况。术后1个月评估围手术期并发症。顺行阴囊硬化疗法后12个月，所有患者均接受多普勒超声检查。对有精液损害的患者还进行了精液分析。失败定义为至少多普勒分级为1级的精索静脉曲张。
697例分析患者的中位年龄为28岁。平均手术时间为15分钟。所有手术均采用局部麻醉，未观察到术中并发症。所有患者均在4小时内出院。35例患者（5%）出现术后并发症，63例（9%）出现失败。青少年中6.5%、成人中9.4%以及复发性精索静脉曲张患者中7.5%观察到持续反流。不同分级和患侧的失败率相似。在学习曲线期间接受手术的患者失败率显著更高（p = 0.007）。在414例有精液损害的患者中，术后中位精子计数、中位进行性运动百分比和正常形态百分比显著改善（p <0.001）。
考虑到所有患者类别（青少年、成人、初诊、双侧及复发性疾病）的低复发率和并发症发生率，顺行阴囊硬化疗法可作为精索静脉曲张安全有效的首选治疗方法。需要特定的学习曲线以获得最佳结果。
