Varicocele is one of the causes of male infertility. Treatment aims to improve the chance of conception despite lasting controversies about benefits of varicocele repair on fertility. Many techniques have been described for varicocele management including the antegrade scrotal sclerotherapy (ASS). Interestingly, ASS is often presented as a safe, easy, and cost-effective procedure with low recurrence and complication rates. However, we report the first case of spinal cord paralysis following ASS probably due to embolization of venous anastomoses between left spermatic and ascending lumbar veins, which were undetected at preoperative phlebography. Based on this case and recent literature, we raise questions about the safety of ASS and try to figure out what would be the best way to improve the detectability of potential harmful anastomoses at preoperative phlebography.

Keywords:
Varicocele, Infertility, Male, Sclerotherapy, Postoperative complications, Spinal cord injury
1.
Keene DJB, Cervellione RM: Antegrade sclerotherapy in adolescent varicocele patients. J Pediatr Urol 2017; 13: 305.e1–e305.e6.
2.
May M, Johannsen M, Beutner S, Helke C, Braun KP, Lein M, Roigas J, Hoschke B: Laparoscopic surgery versus antegrade scrotal sclerotherapy: retrospective comparison of two different approaches for varicocele treatment. Eur Urol 2006; 49: 384–387.
3.
Tauber R, Pfeiffer D: Surgical atlas varicocele: antegrade scrotal sclerotherapy. BJU Int 2006; 98: 1333–1344.
4.
Galfano A, Novara G, Iafrate M, Fracalanza S, Novella G, Cavalleri S, Artibani W, Ficarra V: Surgical outcomes after modified antegrade scrotal sclerotherapy: a prospective analysis of 700 consecutive patients with idiopathic varicocele. J Urol 2008; 179: 1933–1937.
5.
Heller SL, Meyer JR, Russell EJ: Spinal cord venous infarction following endoscopic sclerotherapy for esophageal varices. Neurology 1996; 47: 1081–1085.
6.
Wong YS, Chung KL, Lo KW, Liu CS, Fan TW, Tse SK, Tang PM, Chao NS, Liu KK, Leung MW: Scrotal antegradesclerotherapy demonstrates anatomical variations on venous drainage in paediatric, adolescent and young adult varicoceles. Pediatr Surg Int 2014; 30: 107–111.
7.
Bahren W, Lenz M, Porst H, Wierschin W: [Side effects, complications and contraindications for percutaneous sclerotherapy of the internal spermatic vein in the treatment of idiopathic varicocele]. Rofo 1983; 138: 172–179.
8.
Vicini P, Di Pierro GB, Grande P, Voria G, Antonini G, De Marco F, Di Nicola S, Gentile V: Large bowel infarct following antegrade scrotal sclerotherapy for varicocele: a case report. Can Urol Assoc J 2014; 8:E641–E643.
9.
Kistner RL, Ferris EB, Randhawa G, Kamida C: A method of performing descending venography. J Vasc Surg 1986; 4: 464–468.
© 2017 S. Karger AG, Basel
2017
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