Recurrent varicocele demonstrates distinct venographic patterns depending on prior treatment modality, with technical success significantly lower in patients with recurrent varicocele after prior embolization (57%) compared to 100% success in primary and post-microsurgery groups.
Key Findings
Results
Technical success rates differed significantly across the three patient groups, with prior embolization patients having substantially lower success.
Technical success was achieved in 100% of patients in both the primary varicocele (n=43) and recurrent varicocele after microsurgery (n=42) groups.
Technical success was significantly lower in patients with recurrent varicocele after prior embolization (57%; n=7; P < .001).
The study included 92 consecutive patients stratified into 3 groups over a period from January 2021 to June 2023 at a single academic center.
Results
Venographic presence of a patent refluxing internal spermatic vein varied systematically by prior treatment type.
A patent refluxing internal spermatic vein was consistently present in both the primary varicocele and recurrent varicocele after microsurgery groups.
The patent refluxing internal spermatic vein was absent in the recurrent varicocele after prior embolization group (P < .001).
This finding suggests that prior embolization obliterates the main refluxing vessel, fundamentally altering the venographic anatomy.
Results
Venous collaterals were identified at different rates across the three groups.
Venous collaterals were identified in 86% of primary varicocele cases, 67% of recurrent varicocele after microsurgery cases, and 100% of recurrent varicocele after prior embolization cases.
The difference in collateral presence across groups was statistically significant (P = .033).
All patients with recurrent varicocele after prior embolization had collateral channels, suggesting collaterals are the primary anatomical substrate for recurrence after embolization.
Results
Procedure times differed significantly among the three groups, with prior embolization recurrences taking the longest.
Median procedure time for primary varicocele was 18 minutes (IQR = 15–28).
Median procedure time for recurrent varicocele after microsurgery was 23 minutes (IQR = 18–30.3).
Median procedure time for recurrent varicocele after prior embolization was 31 minutes (IQR = 26.5–41.5); overall difference P = .017.
Results
Radiation dose differed significantly among the three groups.
Median radiation dose was 131 mGy (IQR = 91.8–166.5) for primary varicocele.
Median radiation dose was 120 mGy (IQR = 85.25–192) for recurrent varicocele after microsurgery.
Median radiation dose was 195 mGy (IQR = 151.5–207.5) for recurrent varicocele after prior embolization; overall difference P = .03.
Results
The number of coils used was comparable across all three patient groups.
The median number of coils used was 4 (IQR = 3–4) across all groups.
The difference in coil use among groups was not statistically significant (P = .62).
Despite differences in procedural complexity and venographic anatomy, coil utilization did not vary meaningfully.
Discussion
Recognizing distinct venographic patterns by prior treatment modality may inform procedural planning and patient counseling in recurrent varicocele cases.
The study was retrospective and conducted at a single academic center, which may limit generalizability.
The recurrent varicocele after prior embolization group was small (n=7), which may limit statistical power for that subgroup.
The authors conclude that venographic pattern recognition specific to treatment history is clinically relevant for pre-procedural planning.
What This Means
This research examined how the outcomes and vein anatomy observed during varicocele embolization (a minimally invasive procedure that blocks abnormal veins in the scrotum) differ depending on whether a patient is being treated for the first time or for a recurrence after previous surgery or a prior embolization. The study reviewed 92 patients divided into three groups: those with a new (primary) varicocele, those whose varicocele returned after microsurgery, and those whose varicocele returned after a prior embolization. The researchers found that the procedure was fully successful in 100% of patients in the first two groups, but only 57% of patients whose varicocele recurred after a previous embolization, indicating that this last group is significantly harder to treat.
The study also found that the anatomy of the veins looked very different depending on the patient's treatment history. In patients with a recurrence after prior embolization, the main refluxing vein was always blocked (from the prior procedure), and the recurrence was entirely driven by smaller collateral (bypass) blood vessels — which were present in all of these patients. This anatomical difference helps explain why these cases take longer (median 31 minutes versus 18 minutes for new cases) and expose patients to more radiation (median 195 mGy versus 131 mGy for new cases).
This research suggests that doctors performing varicocele embolization should anticipate more complex anatomy and a higher chance of technical difficulty when treating patients who have already had a prior embolization. Understanding these differences in advance could help with procedural planning and in setting realistic expectations with patients before the procedure.
Alharbi S. (2026). Technical and venographic variations in embolization of primary versus recurrent varicocele: A retrospective single-center study.. Medicine. https://doi.org/10.1097/MD.0000000000050342