About VARICOCELE EMBOLIZATION
Varicocele embolization is a proven, highly effective procedure with excellent treatment outcomes for dilated veins in the scrotum around the testicle.
The treatment is as effective as surgery with less risk, less pain and a significantly shorter recovery period. We work closely with your urologist to make sure that prostate varicocele embolization is an appropriate therapy.
Varicocele embolization is a minimally invasive procedure outpatient procedure. Minimally invasive means it does not involve surgery. It is performed by an interventional radiologist using image-guided techniques in a special angiography suite in an outpatient setting. Typically mild IV sedation and local anesthesia are used.
What is a varicocele?
A varicocele is a dilated vein in the scrotum around the testicle. It may cause pain and heaviness in the area. Healthy veins within the scrotum contain one-way valves that allow blood to flow from the testicles and scrotum back to the heart. When you have a varicocele, these valves do not function properly; this causes the blood to pool which enlarges the vein.
A varicocele can lead to testicular atrophy (shrinkage of the testicles) and possibly contribute to infertility. Some experts believe that the elevated temperature resulting from the pooled blood in these veins can decrease sperm count and motility, and decrease the number of functional sperm.
What is the prevalence of varicoceles?
Varicocele is more common in younger men:
- Approximately 10 percent of all men have varicoceles
- The highest occurrence of varicoceles is in males ages 15–35
- Among infertile couples, 30 percent of men have varicoceles
What are the symptoms of a varicocele?
Symptoms of a varicocele may include:
- Pain. Men who experience aching pain in their testicles—often when exercising, standing or sitting for a long time—may have varicoceles. The pain is due to pressure that builds up on the affected veins. Heavy lifting may aggravate the symptoms and in some cases, may cause a varicocele to form. Sometimes — but not always — the painful varicoceles can be prominent in size.
- Fertility Problems. There is an association between varicoceles and infertility. Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm can be related to varicoceles. Some experts believe that varicoceles cause infertility by raising the temperature in the scrotum and decreasing sperm production.
- Testicular Atrophy. Shrinkage of the testicles is another symptom of varicoceles. Once treated, it is possible for the affected testicles to return to normal size.
How is a varicocele diagnosed?
Diagnosis is fairly simple through either physical or diagnostic imaging examination, such as ultrasound.
Upon physical examination, the scrotum may look like a bag of worms or may be shrunken in size. Approximately 95 per cent of varicoceles are found on the left side of the scrotum.
When not detected by physical exam, a non-invasive imaging exam called a venogram (color flow ultrasound) may be used to detect abnormal blood flow. This is an X-ray in which a special dye is injected into the veins to “highlight” blood vessel abnormalities.
How is a varicocele treated? There are both surgical and a non-surgical options. Patients are encouraged to explore their treatment options.
Traditionally, open surgical ligation, typically performed by a urologist, has been the most common treatment for symptomatic varicocele. In this procedure, an incision is made in the skin above the scrotum down to the testicular veins, which are tied off with sutures. Although most surgical ligation patients leave the hospital the same day, some require an overnight stay. The expected recovery period is between two and three weeks.
Varicocele embolization is a minimally invasive, nonsurgical treatment performed by an interventional radiologist. It is as effective as surgery with less risk, less pain and a significantly shorter recovery period.
Benefits of Varicocele Embolization
Here’s how varicocele embolization compares to surgical ligation.
- No surgical incision in the scrotal area
- No sutures No general anesthesia
- Decreased risk of infection
- Shorter recovery time
- As effective as surgery (as measured by improvement in semen analysis and pregnancy rates)
- Outpatient procedure typically without an overnight hospital stay
- A patient with varicoceles on both sides can have them fixed simultaneously through one vein puncture site, compared to surgery which requires two separate open incisions
- Cost effective
How do I get ready for the procedure?
Following your consultation, RIA Endovascular will supply you with instructions to prepare for the procedure. These are general instructions, and your instructions may differ, but in general the following is the preparation for the procedure:
- Do not take any blood-thinning agents (such as NSAIDS, aspirin, Coumadin, Warfarin) for five days prior to the procedure.
- Do not eat after midnight. (By fasting, we have the option to use sedation if necessary.)
- You may have clear liquids up to four hours prior to the procedure.
- It is okay to take your morning medicines with a sip of water.
- On your scheduled date, please check in at the hospital registration desk.
What should I expect on the day of the Varicocele Embolization procedure?
Once paperwork is completed, an IV will be started. After some mild sedation, local anesthetic is will be used for vein access at the groin or neck.
For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin or the neck using local anesthesia, through which a thin catheter is passed into the vein directly to the gonadal vein.
The physician then injects contrast dye to facilitate direct visualization of the veins to map out exactly where the problem is and where to embolize, or block, the vein.
A small catheter (less than 2mm in diameter) is inserted from the right groin into the veins that drain the varicocele. This does not hurt. Medical-grade material (such as coils, balloons or particles, depending on what is right for you) are then placed into the vein through the catheter to block the blood flow of the vein.
This reduces pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways. Essentially, the incompetent vein is “shut off” internally by preventing blood flow.
At the end of the procedure, the catheter is removed. Pressure is applied to the puncture site after which a small dressing is placed over the area. Rarely, a device is used to help close the vein.
Is the procedure painful?
The procedure is performed with local anesthesia and “twilight” sedation. It is not a painful procedure.
Does the procedure affect sexual function?
No. Sexual function is not affected
After 1-2 hours of recovery time, you will be discharged and allowed to go home after the procedures. Patients are instructed to rest quietly at home that day. For the 72 hours afterwards, limit heavy physical activity. Otherwise, you may resume normal activity the next day. You may experience common side effects such as low-grade fever, pelvic body aches and general fatigue lasting 5-7 days.
Will I have a scar?
During varicocele embolization, no incision is made in or near the testicles. Rather, a tiny nick is made in the leg to insert a catheter (a small tube). Next, the catheter is guided up to the abdomen and into the varicocele vein. After the procedure, the catheter is removed and no stitches are needed.
What are the risks or complications of the procedure?
Minor complications such as bruising at the catheter site, nausea or low-grade backache may occur, but are uncommon. You may experience a low-grade fever, pelvic body aches and general fatigue which can last up to a week.
Will the procedure improve my semen analysis?
Several studies have shown that varicocele repair can improve semen analysis to a significant degree. However, there is no guarantee that any individual will experience a significant improvement after undergoing this procedure. It is known that pregnancy rates in infertile couples improve after varicocele repair between 30% and 50%.
Will insurance pay for varicocele embolization?
Generally, insurance companies will pay for the varicocele embolization if they pay for varicocele surgery.
Some insurance companies limit the coverage provided for infertility treatment.
For further information, please review your insurance policy and-or contact your insurance provider. Each plan is different.
After your consultation, if you require insurance authorization, our dedicated in-house precertification specialist will assist in your precertification and authorization process.