Non Surgical Treatment of Varicocele : An Underutilized Safe Alternative
A varicocele is a varicose vein of the testes and scrotum that may cause pain and result inshrinkage of the testicles.
In healthy veins in the scrotum, one-way valves permit blood to flow from the testes and scrotum back to the heart. In a varicocele, these valves do not function correctly, which causes blood to pool and enlarges the vein. Some experts believe that the rise in temperature that is a result from the pooled blood in these blocked veins can lessen the sperm count and motility of sperm and can increase the number of malformed sperm. In fact, the incidence of varicoceles increases to 30 percent in couples who are not able to have children.
Veins contain one-way valves that work to allow blood to flow from the testes and scrotum back to the heart. When these valves do not work properly, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele to form. Performed by a urologist, open ligation is the most common treatment of varicoceles that cause symptoms for the patient. Varicocele embolization, a nonsurgical treatment performed by an interventional radiologist, is as effective as surgery with less risk involved, less pain and less time for recovery. Patients who are considering surgical treatment should also get a second opinion from an interventional radiologist to make sure they know all of their treatment options for varicoceles. You can always ask for a referral from your doctor, call the radiology department of your hospital and ask for an interventional radiologist or visit the doctor locator link at the top of this page to find a doctor near you.
How common is it ?
- About 10 percent of all men have varicoceles.
- Among infertile couples, 30 percent of men have varicoceles.
- The highest occurrence of varicoceles is in men ages 15–35.
- 80,000–100,000 men may undergo surgical correction of varicoceles each year.
Pain: Men who experience pain in their testes—especially while exercising, standing or sitting for a long period of time—may have varicoceles. Usually, painful varicoceles are large in size. If not treated, varicoceles may lead to the inability to have children.
Fertility problems: There is an association between varicoceles and infertility. Diminished sperm count, diminshed motility of sperm and a rise in the number of malformed sperm are related to varicoceles. Some doctors believe these blocked and swollen veins around the testes cause infertility by raising the temperature in the scrotum and decreasing the production of sperm.
Testicular atrophy: The shrinking of the testes is another sign of varicoceles. Many times the testes will return to its regular size once it is repaired.
Varicocele Diagnosis :
Varicoceles are easy to catch and diagnose through physical examination or diagnostic examination.
- Of the 95 percent of varicoceles that are found, they are located on the left side of the scrotum.
- The scrotum looks like a bag of worms.
- The testicles may be shrunken in size.
- On the off chance that varicoceles are not detectable through the above criteria, unusual blood flow can regularly be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram—a radiograph in which a special dye is injected into the veins to “highlight” abnormalities of the blood vessels.
Varicocele : Treatment Options
Both surgical and nonsurgical options are available.
Catheter-directed embolization or varicocele embolization:
Catheter-directed embolization, or varicocele embolization is a nonsurgical procedure done by an interventional radiologist, which is highly effective and a widely available procedure to treat varicoceles symptoms. During this nonsurgical procedure, an interventional radiologist uses catheters and other instruments to close off blood flow to the dysfunctional vein. During this procedure, the patient is free of pain and relaxed.
The interventional radiologist specifically makes a tiny incision in the skin at the groin using localized anesthesia, then a thin catheter (much like the size of spaghetti) is threaded into the femoral vein, directly to the testicular vein. The radiologist then injects contrast dye to give exact visualization of the veins to draw out exactly where the varicocele is and where to perform the varicocele embolization, or blocking of the vein. By using sclerosants or coils (injected medicine that goes into the blood vessels to shrink them), the interventional radiologist blocks the abnormal veins, thus reducing pressure on the varicocele. By doing the varicocele embolization, blood flow is directed to other pathways. Varicocele embolization essentially stops blood flow internally, therefore, accomplishing what the urologist does without a surgical procedure.
One of the most common varicocele treatments is open surgical litigation. During open surgical litigation, typically performed by a urologist, a cut is made in the skin above the scrotum down to the testicular veins. The veins are then tied off with sutures. 24 percent of surgical litigation patients are required to stay overnight in the hospital while most patients are able to leave the hospital the same day. After open surgical ligation, patients can expect a two to three week recuperation period.
Advantages of Catheter-directed Embolization
- Cost effective
- No surgical incision in scrotal area
- No general anesthesia required
- No sutures
- No infections
- As effective as surgery, as measured by improvement in semen analysis and pregnancy rates
- Patients can return to normal daily activities immediately and without hospital admittance; surgery requires several weeks’ recovery and hospital admittance
- The rare patient who has varicoceles on both sides can have them fixed simultaneously through one vein puncture site; surgery on both sides requires two separate open incisions