Varicocele Embolization

What is a varicocele?

A varicocele, pronounced var'e-ko-seel, is a network of dilated blood vessels, or varicose veins, in the scrotum. For unknown reasons, varicoceles usually occur in the left testes. Varicoceles are a relatively common condition that tend to occur in young men, usually during the second or third decade of life. This condition affects approximately 15 to 20% of the general male population and up to 40% of infertile males.

What are the signs and symptoms?

Typical varicocele symptoms are mild and many do not require treatment. Treatment may be necessary if the varicocele is causing discomfort or any of the other problems listed below.

Pain

One of the signs of varicoceles is an aching pain when one has been standing or sitting for an extended time and pressure builds up in the affected veins. Heavy lifting may make varicocele symptoms worse.

Fertility Problems

There is an association between varicoceles and infertility or subfertility, but it is difficult to be certain if a varicocele is the cause of fertility problems in any one case. Other signs of varicoceles can be a decreased sperm count; decreased motility, or movement, of sperm; and an increase in the number of deformed sperm. It is not known for sure how varicoceles contribute to these problems, but a common theory is that the condition raises the temperature of the testicles and affects sperm production.

Testicular Atrophy

Atrophy, or shrinking, of the testicles may occur. When the affected testicle is smaller than the other, repair of the variocele is often recommended. The repaired testicle will return to normal size in many cases.

What is a varicocele embolization?

Varicocele embolization is a safe and effective non-surgical treatment for management of symptomatic varicoceles. A catheter is placed in the spermatic vein and small particles are injected to block the veins that supply blood to the varicocele. The spermatic vein is blocked off and in most cases symptoms are relieved. Varicocele embolization, done under local anesthesia, is much less invasive than open surgery done to remove the varicose veins.

How is a varicocele embolization performed?

Several days prior to the procedure you will be given instructions from the Interventional Radiologist's office staff. You will need to have blood drawn at the hospital or a local clinic for testing. The staff will instruct you on how to prepare for the procedure including modification of your medications if necessary.

The procedure is performed in the interventional radiology suite. First, the nurse will give you a sedative through the intravenous line, which will be placed in your arm. You will feel relaxed and sleepy, but you will be awake throughout the procedure. The Interventional Radiologist will numb an area of your neck with a local anesthetic. Using a very small incision, he will then place a small, thin tube called a catheter into the jugular vein in the neck or the femoral vein. The Interventional Radiologist will then advance the catheter from the jugular vein or the femoral vein into the inferior vena cava and into the spermatic vein. An angiogram, which an x-ray procedure that studies the arteries or veins, will then be performed to determine the anatomy of the varicocele. Because arteries and veins cannot be seen under x-ray, contrast media (x-ray dye) is used to visualize the vessels under x-ray.

Embolic materials will then be advanced through the catheter into the spermatic vein to block the blood flow to the varicocele. Once the varicocle is occluded, the catheter will be removed and the Interventional Radiologist will apply pressure at the neck site for about 10 minutes to prevent bleeding.

The embolic materials used may vary. The most common materials are stainless steel coils coated with fibers to facilitate blood clotting.

Most patients are discharged within 6 hours after the procedure. The majority of patients are able to return to normal activities within one week.

Procedure Results:

There is a 90% success rate with embolization, and of those with success, about 10% may experience late recurrence. These results are the same as those achieved with more invasive surgical techniques.

Studies have shown that varicocele embolization can improve semen analysis significantly, but there is no guarantee that any individual patient will experience a significant improvement. Pregnancy rates in infertile couples improve after varicocele repair by about 30-50%.

Successful varicocele repair reduces the swelling and discomfort of symptomatic varicoceles. There are other causes of scrotal pain that may need to be ruled out before varicocele treatment.