Varicocoele Embolization
What is it?
A varicocele is an enlargement of the network of veins in the scrotum (called the pampiniform plexus). This may be felt, and is often visible. It is similar to varicose veins within the leg. It is a common condition, with as many as 15 out of every 100 males suffering from this condition. It usually affects the left testis, but may on occasion affect the right, or even both.
What are the symptoms?
Most men complain of an enlarged testis, and they can usually feel the swelling of the veins. In most cases, however, varicoceles are small, and remain harmless.
When the varicoceles become large, they can result in pain and swelling, and is also associated with male infertility.
what are the surgical treatment options?
Traditionally surgery has been the initial treatment of choice, although there are many different techniques:
- Microsurgical sub-inguinal or inguinal varicocelectomy involves using a microscope to identify the various veins and tying them off. This is arguably the best surgical approach, with the lowest recurrence rate. Most men are able to go back to normal activity after 2 days.
- Non-microsurgical sub-inguinal or inguinal varicocelectomy are similar procedures, but are performed without the aid of a microscope, and as such some of the veins are sometimes missed, with a higher recurrence rate than microsurgical techniques.
- Retro-peritoneal high ligation involves tying off the testicular vein closer to where it joins the renal vein. This approach has a higher recurrence rate than microsurgical techniques.
Recurrence rates vary from study to study, but are usually between 10% and 35%. These procedures require a general anaesthetic, and a few days off from work.
What about varicocele embolization?
The procedure is usually performed on men who have suffered recurrence of their varicocele.
This can be performed as a day case, under local anaesthetic (although for anxious patients we can perform it under general anaesthetia).
Complications are rare, and usually very benign.
The recurrence rate of varicoceles after embolization varies from study to study, but is usually quoted as between 5 and 20%.
what does the procedure entail?
- Patients are admitted to the hospital the morning of the procedure.
- The procedure is performed by one of our Interventional Radiologists, in our X-ray suite, where our staff constantly monitor our patients, making sure they are comfortable.
- A catheter is introduced into the jugular vein, on the right hand side of the neck. From there, the catheter is navigated into the testicular vein, using X-ray guidance.
- Pictures of the veins are made using a small amount of dye. This shows us where all the potential draining veins are. These are then accessed and blocked using small metal coils, or a special foam, whichever will work best.
- Patients do not feel any pain or discomfort while the procedure is happening, and sedation is usually not required.
- After all of the veins are blocked off, the catheter is removed, and a small dressing is applied to the neck. The patient is then transferred back to the ward
- The Interventional Radiologist will then come to the ward, assess the access site in the neck one last time, and discharge the patient.
- Although a follow up appointment is not necessary, we call all of our patients a few days after the procedure to check that everything is alright. Our patients are also given a contact number to call in case there are any further questions or any problems occur.