Anastomoses between the spermatic and visceral veins: A retrospective study of 500 consecutive patients

Background: Do visceral-spermatic vein shunts have any clinical impact on sclerotherapy of varicoceles? Methods: The spermatic venograms of 500 consecutive patients were retrospectively reviewed to classify visceral-spermatic communications. Men with an average age of 27.8 years (range 11-65 years old) underwent sclerotherapy of a varicocele. Of the 500 men, 445 were referred for oligoasthenospermia (89%), 45 for pain (9%), and 10 for prevention of infertility (2%). After bilateral catheterization, percutaneous sclerosis was performed below the upper third of the sacroiliac joint. Results. Three hundred forty patients (68%) had left-sided, 10 (2%) had right-sided, and 150 (30%) had bilateral varicoceles. Left side: Of 46 (9.4%) anastomoses, one (0.2%) communicated with the splenic vein and 45 (9.2%) with the inferior mesenteric vein of which 25 (5.1%) were a colic trunk with a competent valve, 15 (3.1%) were venules, and five (1%) were a single or double anastomosis. Right side: Of 48 (29.6%) anastomoses to the superior mesenteric vein, 34 (21%) were venules, 12 (7.4%) were a colic trunk with a competent valve, and two (1.2%) were a single or double vein. Our varicocele recurrence rate was only 1.2%. Conclusion. Visceral-spermatic vein communications are classified by number, morphology, and site. Percutaneous sclerotherapy could be optimized when performed caudally to these communications.