- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03341897
Varicocele Treatement by Endovasculer Embolization
Endovasculer Treatement of Male Pelvic Venous Insufficiency
A varicocele is a collection of varicose veins within the pampiniform (spermatic) plexus secondary to reflux in the internal spermatic vein (ISV).The condition affects 10% to 15% of the general population but is detected in as many as 40% of men undergoing an infertility workup. Depending on the method used for diagnosis, varicoceles are reported as bilateral in 17% to 77% of men. Traditionally, the diagnosis was made through clinical examination; however,as with other venous reflux disorders, ultrasound has become the mainstay of diagnosis. The traditional indications for treatment include infertility in patients with appropriate semen abnormalities, chronic groin pain, testicular atrophy in adolescent varicoceles, and recurrent varicocele after previous repair. Other indications more recently described with variable strength of evidence include low serum testosterone (with or without erectile dysfunction), benign prostatic hypertrophy,enhancement of assisted fertility techniques, and recurrent first trimester pregnancy loss.Infertility affects 10% to 15% of men of reproductive age. In approximately 50%, a cause is not found. The proof that varicocele repair improves fertility remains elusive; however, there is general acceptance that treatment does improve abnormalities of semen production.The traditional measures to assess semen production are sperm motility,morphology, and total sperm count. However, sperm counts greatly vary from day to day in any individual patient, and these measures correlate poorly with infertility outcomes.
The investigators do this study to evaluate the effectiveness of endovascular therapy using coils and other sclerosing agents and compare their results with other traditonal surgical methods in treatement of varicocele.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
All included patients will undergo the following:
- History & examination
- Semen analysis preintervention.
- Scrotal duplex scan of testicular vessels and testicular size .
Technique:
- All interventions will be performed in the endovascular OR with set on C-ARM.
- Patient's position and comfort are issues that are important initially.
STEPS FOR SPERMATIC VENOGRAPHY AND VARICOCELE EMBOLIZATION
Step 1: Vascular Access
Access can be achieved via the internal jugular or femo¬ral veins. Our preferred method is to puncture the right internal jugular vein under ultrasound guidance.
Step 2: Left Renal Vein Injection
During left renal vein injection, the origin of the left spermatic vein is noted .
Step 3: Left Spermatic Vein Catheterization
The catheter is manipulated into the left spermatic vein. A varicocele is present if the contrast refluxes into the pampiniform plexus. If the direction of flow is antegrade, this is considered to represent a negative spermatic venogram.
Step 4: Spermatic Vein Occlusion
If varicocele is confirmed, the spermatic vein is occluded, preferably immediately above the internal inguinal ring and along its full length to within 2 to 3 cm of its origin. The use of liquid embolics with or without metallic coils has become the most common method. Embolization with coils alone without liquid should be avoided, even for "straightforward" cases due to a high rate of recurrence. It is important to look for collaterals throughout the procedure, which may only become visible after distal occlusion . These collaterals are the usual cause of technical failure or recurrence and therefore must be occluded. Options for occlusion methods are described as follows.
Some practitioners place coils in the distal ISV before injecting glue. Coils in the proximal ISV are not necessary. Avoiding injection of glue into the scrotum is essential, either by previously placed distal coils or external compression. Overinjection of glue will result in extension into the renal vein or embolization into the pulmonary artery.
Step 5: Right Spermatic Venography
The same steps performed for the left spermatic vein are repeated for the right spermatic vein, except that the right spermatic vein usually arises directly from the infe¬rior vena cava. If reflux is demonstrated, embolization is performed in the same manner as on the left. The right spermatic vein arises from the inferior vena cava at an acute angle, which can make catheterization from the femoral route especially difficult.
POSTPROCEDURE CARE
The patient is kept in bed for 1 hour postprocedure. The patient is advised to take anti-inflammatory agents as needed and to avoid any activity involving the Valsalva maneuver, such as lifting, vigorous, or "hitting type" sports for 3 full days beginning the day after the proce¬dure. Most patients report a minor dull ache in the back or groin lasting < 2 to 5 days. Fewer than 5% of patients will develop more severe pain lasting up to 14 days, requiring oral analgesics and anti-inflammatory agents and avoidance of vigorous exercise
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age between 18 to 40 years.
- Grade three reflux by duplex ultrasound..
- Recurrent varicocele after surgical treatement.
Exclusion Criteria:
- Any contraindication for endovascular therapy regarding radiation or dye or sclerosing agents.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Surgical varicocelectomy
|
Step 1: Vascular Access Access can be achieved via the internal jugular or femoral veins. Step 2: Left Renal Vein Injection Step 3: Left Spermatic Vein Catheterization Step 4: Spermatic Vein Occlusion Step 5: Right Spermatic Venography POSTPROCEDURE CARE The patient is kept in bed for 1 hour postprocedure. The patient is advised to take anti-inflammatory agents as needed and to avoid any activity involving the Valsalva maneuver, such as lifting, vigorous, or "hitting type" sports for 3 full days beginning the day after the proce¬dure. Most patients report a minor dull ache in the back or groin lasting < 2 to 5 days. Fewer than 5% of patients will develop more severe pain lasting up to 14 days, requiring oral analgesics and anti-inflammatory agents and avoidance of vigorous exercise. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
semen analyis criteria
Time Frame: 3 month
|
sperm number in milion/ml
|
3 month
|
semen analysis criteria
Time Frame: 3 month
|
sperm motility
|
3 month
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- VARICOCELE TREATEMENT
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Varicocele
-
First Affiliated Hospital, Sun Yat-Sen UniversityUnknownVaricocele; Male Infertile;VaricocelectomyChina
-
Sohag UniversityUnknownICSI AZOOSPERMIA VARICOCELEEgypt
-
Assiut UniversityNot yet recruiting
-
Assiut UniversityNot yet recruiting
-
Feng PanCompleted
-
Ömer Faruk BoranUnknown
-
Medical University of WarsawUnknown
-
Seoul National University HospitalCompletedVaricoceleKorea, Republic of
-
Yale UniversityUniversity of Colorado, Denver; Eunice Kennedy Shriver National Institute of... and other collaboratorsTerminatedInfertility | PregnancyUnited States
-
Al-Yasmeen Fertility and Gynecology CenterBanon IVF Center Assiut, Egypt; Elite Fertility and Gynecology Center, Cairo... and other collaboratorsNot yet recruitingInfertility, Male
Clinical Trials on endovasculer embolization of varicocele
-
Shaare Zedek Medical CenterUnknownIn Vitro Fertilization | Infertility, Male | Varicocele
-
Group of Research in Minimally Invasive TechniquesUniversidad de Zaragoza; Hospital Clínico Universitario Lozano BlesaWithdrawnBenign Prostatic HyperplasiaSpain
-
Vascular Neurology of Southern California Inc.RecruitingAneurysm | Subarachnoid Hemorrhage, Aneurysmal | Intracranial Aneurysm | Ruptured Aneurysm | Cerebral Aneurysm UnrupturedUnited States
-
St. Olavs HospitalTerminatedVaricose Veins | Pelvic PainNorway
-
Univ.-Prof. Dr. med. Hans-Henning EcksteinTechnical University of Munich; St. Josefs-Hospital Wiesbaden GmbH; University... and other collaboratorsRecruitingAbdominal Aortic Aneurysm | EndoleakGermany
-
Tennessee Neurovascular Institute, LLCUnknown
-
Second Affiliated Hospital, School of Medicine,...Shandong Provincial Hospital Affiliated to Shandong First Medical University and other collaboratorsNot yet recruitingEsophageal and Gastric Varices
-
Vascular Institute of VirginiaTerumo Medical CorporationUnknownAdhesive Capsulitis | Frozen ShoulderUnited States
-
University of CalgaryIMBiotechnologies Ltd.Not yet recruiting
-
Ospedale Policlinico San MartinoNot yet recruitingEndovascular vs Conservative Treatment in Patients With Chronic Subdural Hematomas and Mild SymptomsSubdural Hematoma, Chronic