Varicocele Q&A with Dr. Harrison
Varicoceles are enlarged varicose veins that occur in the scrotum. Besides being painful, they can cause problems with fertility. Studies indicate approximately 15% of men suffer from varicoceles and 40% in males who have fertility issues.
We interviewed Dr. Jonathan Harrison on varicoceles and how they are treated. Here is what he had to say:
Introduction
Dr. Harrison: My name is Jonathan Harrison. I have been at IVC for approximately 3 years. I previously practiced in Las Vegas for 3 years as well.
Dr. Jonathan Harrison is fellowship-trained and board certified in interventional radiology. His expertise includes treatment of disorders of arterial and venous circulation, acute stroke intervention, and therapeutic embolization.
What is a varicocele?
Dr. Harrison: A varicocele is a small little cluster of veins, varicose veins, that occur in the scrotum. Most varicose veins occur because of reflux or incompetent or inefficient veins. And the same thing is happening in the scrotum. The actual vein that is happening in is called the spermatic vein.
What are the symptoms of a varicocele?
Dr. Harrison: The symptoms of varicocele are very common amongst patients. First of all, its all male because its in the spermatic vein and the varicose veins are occurring in the scrotum. The symptoms when you have these is a dull aching pain that is more severe when you have been standing for much of the day or when you have been doing a lot of exercise or a lot of work that requires a lot of lifting.
Who does a varicocele typically affect?
Dr. Harrison: Varicoceles affect approximately 10-15% of the general population of males. Sometimes a male may have a varicocele and not even know that they have it. They present typically present to us because they have been having the symptoms that we have talked about.
How are varicoceles diagnosed?
Dr. Harrison: Varicoceles are diagnosed by clinical symptoms, number 1. And number 2, with an ultrasound of the scrotum.
Do varicoceles affect fertility?
Dr. Harrison: Varicoceles can affect fertility. We have found that males who experience infertility issues, 30-40% of them have a varicocele. The mechanism in which this occurs, we think, is secondary to increased temperature that occurs around the scrotum because of these varicose veins. That increased temperature can inhibit sperm production and make fertility issues more prominent.
40% of men who experience fertility problems have a varicocele.
How are varicoceles treated?
Dr. Harrison: So, there are two ways in which a varicocele can be treated. Traditionally you can go the surgical route. Surgical route occurs in which you go to surgery and they identify the veins that are incompetent, these spermatic veins, and they actually go in and they clip them, surgically. So they don’t have any more problems with reflux. The more recent development in treatment is called varicocele embolization, which we specialize in. Varicocele embolization is where we go endovascularly into these veins with little tiny wires and catheters and we insert a little bit of irritative foam or little titanium coils into the vein and close those veins down so that reflux doesn’t occur anymore. Thereby resolving the varicocele.
What are the advantages of varicocele embolization?
Dr. Harrison: The advantages of varicocele embolization are many. First of all, when you compare them to the actual surgery that can also be done for this, the embolization is minimally invasive. Therefore, on the day of your procedure you’re coming in in the morning, you are getting your procedure done, it takes about an hour to do it. And then you’re leaving about two hours later. The other advantage for varicocele embolization is it is more affordable versus surgery. The outcomes between the two, surgery and embolization, are equivalent. You’re not getting any difference in outcomes between the two.
How effective is embolization?
Dr. Harrison: We have found that it is very effective. First of all, what we are trying to do is twofold. If you are coming in because of pain or discomfort, we have found that over 75% of patients report vastly improved discomfort and pain several months after the procedure. If you are coming in for fertility issues, we have found greatly increased predictors of improved fertility. Those predictors are mainly focused on the semen quality and the sperm count and sperm motility.
Is embolization painful?
Dr. Harrison: The actual procedure of embolization is not painful. You do, and it is common to have a little bit of discomfort afterwards for one or two days in the form of back pain or a little bit of scrotal swelling.
How is the recovery from embolization?
Dr. Harrison: The recovery of embolization is very easy. You are able to go to work the next day. Then you are able to manage any mild discomfort with Tylenol or with ibuprofen.
How long before the patient feels relief?
Dr. Harrison: The symptomatic relief that a patient will feel from a varicocele embolization will occur within the first few weeks after the procedure is done, if they are coming in for pain and discomfort. If they are coming in for fertility issues, it typically takes about three months for the improved sperm production and semen quality to get up to where it should be.
Are there any restrictions post-treatment?
Dr. Harrison: The restrictions post-treatment for a varicocele embolization are very minor. We ask that a patient abstains from physical activity for about three days. They are able to go to work the next day. But after that you can participate in all normal activities.
