Varicocele Treatment Options

In the United States, varicocele treatment has traditionally involved open surgery, usually performed by a urologic surgeon, or urologist. In recent years however, a safe and effective non-surgical alternative called varicocele embolization is becoming the treatment of choice for many patients and their physicians

Varicocele embolization is an outpatient procedure that is performed without general anesthesia using light sedation. In this type of varicocele treatment, a small tube is inserted into the neck or groin through a small nick in the skin (about the size of the lead in a pencil). The skin is numbed for this procedure and it is not painful. Next a small catheter, or tube, is painlessly guided up into the abdomen and into the varicocele vein under the guidance of x-ray imaging. A dye is injected to create an x-ray map (venogram) of the vein and tiny metal coils or other embolizing substances are inserted through the catheter to block the flow of blood to the vein. The tube is removed and no stitches are needed. Patients are observed for a few hours and go home the same day. Recovery from varicocele embolization typically takes less than 24 hours and patients often return to work the next day.

Advantages of Varicocele Embolization

The majority of men in the United States undergo surgery as varicocele treatment. This is because they are usually sent to surgeons for evaluation, and many do not know about varicocele embolization. The advantages of this alternative, interventional radiology varicocele treatment include:

* It is as effective as surgery, as measured by improvement in semen analysis and pregnancy rates.

* It does not require any surgical incision in the scrotal area.

* A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions).

* General anesthesia is not used for embolization (most surgery is done under general).

* There is a lower rate of complications compared to surgery. Infection has not been reported after embolization.

*It requires less recovery time. Post embolization patients are virtually never admitted to the hospital. Even patients with physically demanding jobs may return to work within the next day or two, unlike post surgical patients.

What Are Varicoceles?

Varicoceles are a relatively common condition (affecting approximately 10 percent of men) that tend to occur in young men, usually during the second or third decade of life. Sometimes these varicoceles cause no symptoms and are harmless, but sometimes a varicocele can cause pain, atrophy (shrinkage), or fertility problems.

Normally blood flows to the testicles through an artery and flows out via a network of tiny veins that drain into a larger vein that travels up through the abdomen. Varicoceles occur when there is a reverse of blood flow. This stretches and enlarges the tiny veins around the testicle to cause a varicocele, a tangled network of blood vessels also known as varicose veins.

One of the signs of a varicocele is an aching pain when the individual has been standing or sitting for an extended time and pressure builds up in the affected veins. Usually (but not always) painful varicoceles are prominent in size. Atrophy, or shrinking, of the testicles is another sign of varicoceles. The condition is often diagnosed in adolescent boys during a sports physical exam. When the affected testicle is smaller than the other, repair of the varicocele is often recommended. The repaired testicle will return to normal size in many cases.

There is an association between varicoceles and infertility or sub-fertility, 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 certain how varicoceles contribute to these problems, but a common theory is that the condition raises the temperature of the testicles and affects sperm production.

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 above.