Page 147 - Remedial Andrology

Table 41: Recurrence and complication rates associated with treatments for varicocele

Treatment Refs. Recurrence/ Overall complications Specific Complications
Persistence %
Antegrade [1723, 1724] 5-9 Hydrocele (5.5%), Technical failure 1-9%,
sclerotherapy haematoma, left-flank erythema
infection, scrotal pain,
testicular atrophy,
epididymitis
Retrograde [1725, 1726] 6-9.8 Hydrocele (3.3%) Technical failure 6-7.5%,
sclerotherapy wound infection, adverse reaction to contrast
scrotal pain medium, flank pain,
persistent thrombophlebitis,
venous perforation
Retrograde [1725, 1727] 3-11 Hydrocele (10%) Technical failure
embolisation haematoma, 7-27%, pain due to
wound infection thrombophlebitis,
radiological complications
(e.g., reaction to contrast
media), misplacement
or migration of coils (to
femoral vein or right
atrium), retroperitoneal
haemorrhage, fibrosis,
ureteric obstruction, venous
perforation
Open operation
Scrotal operation - Testicular atrophy,
arterial damage with
risk of devascularisation
and testicular gangrene,
scrotal haematoma,
post-operative
hydrocele
Inguinal approach [1728, 1729] 2.6-13 Hydrocele (7.3%), Post-operative pain due to
testicular atrophy, incision of external oblique
epididymo-orchitis, fascia, genitofemoral nerve
wound complications damage
Open retroperitoneal [1717, 1730] 15-29 Hydrocele (5-10%), External spermatic vein
high ligation testicular atrophy, ligation failure
scrotal edema
Microsurgical [1718, 1728, 0.4 Hydrocele (0.44%),
inguinal or 1731, 1732] scrotal haematoma
subinguinal
Laparoscopy [1688, 1717, 3-6 Hydrocele (7-43%) External spermatic vein
1718, 1733, epididymitis, ligation failure, intestinal,
1734] wound infection, vascular and nerve damage;
testicular atrophy due to pulmonary embolism;
injury of testicular artery, pneumo-scrotum;
bleeding peritonitis; post-operative
pain in right shoulder (due
to diaphragmatic stretching
during pneumo-peritoneum)

146 SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021