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Place de l’embolisation percutanée de la varicocèle dans le traitement de l’infertilité

Percutaneous embolization of variccele for the treatment of infertility

Résumé

Objectifs

Décrire la technique et les résultats de l’embolisation percutanée des varicocèles et évaluer l’apport de cette technique dans la prise en charge des infertilités.

Matériels et méthodes

Cent-dix-neuf patients âgés de 11 à 48 ans ont bénéficié d’une embolisation percutanée de varicocèle. Une infertilité était l’indication pour 23% des patients. La disparition de la varicocèle et des douleurs, la trophicité du testicule et les éventuelles conséquences sur la fertilité étaient recherchées. Une étude de la littérature concernée est proposée.

Résultats

La technique d’embolisation était réalisée en hospitalisation ambulatoire sous neuroleptanalgésie et associait l’utilisation d’un agent sclérosant et d’embols métalliques (coils) mis en place dans la veine spermatique interne. Le succès technique était 95% dans notre série avec une complication. La disparition de la varicocèle à 3 mois était obtenue dans 98% des cas. L’étude de la littérature montre que les relations entre varicocèle et infertilité sont mal établies mais que le traitement de la varicocèle améliore la fertilité.

Conclusion

Les relations varicocèle- infertilité sont mal élucidées mais il existe un bénéfice démontré de la cure des varicocèles. L’embolisation des varicocèles, alternative peu invasive et aussi efficace que le traitement chirurgical, est pratiquée en première intention après consensus uro-radiologique dans notre institution pour traitement des varicocèles.

Abstract

Objectives

To describe percutaneous embolization of varicocele and to evaluate the effect on fertility disorders.

Materials and methods

One hundred nineteen patients, aged 11 to 48 years, underwent percutaneous embolization for varicocele indicated by a fertility disorder in 23% of cases. Correction of the varicocele and resolution of associated pain, improvement of testicular trophicity and the effect on fertility were studied and a review of the literature was performed.

Results

Percutaneous embolization was performed using neuroleptanalgesia on an outpatient basis. The technique combined venous sclerotherapy and placement of coils in the gonadal vein. The technique was successful in 95% of cases and one complication was observed. At 3 months, the varicocele and related pain had resolved in 98% of treated patients. According to previous reports in the literature, the relations between varicocele and fertility disorders are still unclear, but improvement of fertility (semen quality and conception rates) after varicocele repair has been established.

Conclusion

Although the consequences of varicocele on fertility have not been fully elucidated, treatment of varicocele appears to be beneficial. Percutaneous embolization of varicocele is a safe and effective alternative to surgery. This technique, based on a urological and radiological consensus, is the first-line treatment for varicocele in our institution.

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Correspondence to Olivier Serres-Cousine.

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Serres-Cousine, O., Vernhet, H. Place de l’embolisation percutanée de la varicocèle dans le traitement de l’infertilité. Androl. 12, 194–201 (2002). https://doi.org/10.1007/BF03034965

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Mots-clés

  • varicocèle
  • embolisation
  • azoospermie
  • fertilité

Key-Words

  • varicocele
  • embolization
  • azoospermia
  • fertility
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