Crestani Alessandro, Giannarini Gianluca, Calandriello Mattia, Rossanese Marta, Mancini Mariangela, Novara Giacomo, Ficarra Vincenzo
Academic Medical Centre Hospital Santa Maria della Misericordia; Department of Experimental and Clinic Medical Sciences, Urology Unit, University of Udine, Udine, Italy.
Asian J Androl. 2016 Mar-Apr;18(2):292-5. doi: 10.4103/1008-682X.171658.
Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate. Antegrade scrotal sclerotherapy (ASS) represented one of the main alternatives to the traditional inguinal or suprainguinal surgical ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an original modified technique with a long follow-up. Between December 1997 and December 2014, we performed 674 ASS. Mean operative time was 14 min (range 9 to 50 min). No significant intraoperative complications were reported. Within 90 days from the procedure, postoperative complications were recorded in overall 49 (7.2%) patients. No major complications were recorded. A persistent/recurrent varicocele was detected in 40 (5.9%) cases. In 32/40 (80%) cases, patients showed preoperative grade III varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 × 10 6 to 21 × 10 6 ml-1 (P < 0.001). The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% (P < 0.001). Percentage of normal forms increased from 17% before surgery to 35% 1 year after the procedure (P < 0.001). In the subgroup of the 168 infertile patients, 52 (31%) fathered offspring at a 12-month-minimum follow-up. Therefore, ASS is an effective minimal invasive treatment for varicocele with low recurrence/persistence rate.
精索静脉曲张修复术主要适用于临床可触及精索静脉曲张且精液参数异常的年轻成年患者。精索静脉曲张治疗可显著改善精子浓度、活力、形态及妊娠率。顺行阴囊硬化疗法（ASS）是传统腹股沟或腹股沟上手术结扎的主要替代方法之一。本文综述了ASS在精索静脉曲张治疗中的应用。我们简要概述了该手术的历史，并介绍了我们在ASS中使用的方法。此外，我们回顾了ASS的并发症和成功率，包括我们过去17年治疗674例患者的回顾性数据。在此，我们逐步分析了ASS技术，并描述了我们采用原始改良技术并长期随访的结果。1997年12月至2014年12月，我们共进行了674例ASS手术。平均手术时间为14分钟（范围9至50分钟）。未报告重大术中并发症。在术后90天内，共49例（7.2%）患者出现术后并发症。未记录到重大并发症。40例（5.9%）患者检测到持续性/复发性精索静脉曲张。在40例中的32例（80%）患者中，术前为III级精索静脉曲张。术前精子数量低的患者，精子计数从13×10⁶提高到21×10⁶/ml⁻¹（P<0.001）。1小时时进行性活动形式的百分比中位数从25%提高到45%（P<0.001）。正常形态的百分比从术前的17%增加到术后1年的35%（P<0.001）。在168例不育患者亚组中，在至少12个月的随访中，52例（31%）患者生育了后代。因此，ASS是一种治疗精索静脉曲张的有效微创方法，复发/持续率低。
