What is a varicocele?

A varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems. Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele. Open surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles. Varicocele embolization, a nonsurgical treatment performed by an interventional radiologist, is as effective as surgery with less risk, less pain and less recovery time. Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.

What the symptoms of Varicocele?

  •  Pain - aching pain when an individual has been standing or sitting for long periods of time and pressure builds up on the affected veins. Typically, painful varicoceles are prominent in size.
  •  Fertility Problems - There is an association between varicoceles and infertility. The incidence of varicocele increases to 30 percent in infertile couples. Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. Some experts believe that blocked and enlarged veins around the testes, called varicoceles, cause infertility by raising the temperature in the scrotum and decreasing sperm production.
  •  Testicular Atrophy - Shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired it will return to normal size.

How Is Varicocele diagnosed?

Diagnosis is fairly simple through either physical or diagnostic examination.

  • Typical on left side of scrotum
  • Visual physical exam - scrotum looks like a "bag of worms"
  • Testicle can shrink in size / atrophy
  • When varicoceles are not clearly present, the abnormal blood flow can often be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram - an X-ray in which a special dye is injected into the veins to "highlight" blood vessel abnormalities

How does Interventional Radiology treat Varicocele?

Catheter directed embolization is a non-surgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure.

For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so s/he can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, balloons, or particles, the interventional radiologist blocks the blood flow in the vein which 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, accomplishing what the urologist does, but without surgery.

What are the advantages of Embolization versus surgery?

  • Minimally invasive: there is no large incision and the downtime is minimal. In addition, the procedure is not associated with all the possible complications that can occur after surgery and anesthesia.
  • Anesthesia: there is no need for general anesthesia with embolization. Conscious sedation is used.

How do I prepare for the procedure?

You will be scheduled for a consultation with the Interventional Radiology Team. Bring a list of questions to ask your doctor. It is important that you understand exactly what procedure is planned, the risks, benefits and other options before your procedure.

What happens during the procedure? 

Conscious sedation is provided just prior to starting the procedure. You will be connected to several types of monitoring equipment. You will be lying on the x-ray table. The technologist will prepare the skin over the neck by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work space. Lidocaine® local anesthesia is injected into the skin overlying your neck. A catheter is placed into the vein and contrast dye is injected to allow visualization of the veins that supply the testicles, one side at a time. A sclerosing solution (Sotradecol ®) and platinum coils are injected into the  vein until the blood flow has stopped. Once the procedure is completed the catheter is removed and pressure is applied to the neck until there is no bleeding (approximately 5-10min). This procedure takes approximately 1.5 - 2 hours.

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Figure 1. Depiction of a left varicocele embolization
 

What happens after the procedure? 

This is an outpatient procedure but you will be required to stay to recover for two hours after the end of the procedure. While in recovery, you will be monitored closely for signs of bleeding and to ensure that the effects of the sedation have worn off.  You must have a responsible adult to drive/escort them home from the hospital.

Going home:

Check your dressing throughout the day for any increased drainage.  Keep the dressing dry for 24 hours and then remove.  If you experience excessive bleeding from the skin site, apply pressure to the site and seek medical attention. Report any signs of infection (redness swelling, discharge and fever) to your doctor.  At home you should drink extra fluids for one to two days following the procedure to help flush the contrast that was injected into your body.

What are the results of embolization for Varicocele Embolization?

Embolization is equally effective in improving male infertility and costs about the same as surgical ligation. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy. In one study, sixty percent conceived who were treated for infertility.

In another study, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.

This information is provided by the Fletcher Allen Healthcare Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.

If you have any questions please feel free to contact the Interventional Radiology Office at 802-847-8359