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Testicular Varicocele

What is a varicocele?

Varicoceles are clusters of varicose veins that occur in the scrotum above the testes in 15% of men. A varicose vein is a blood vessel that has absent or weakened valves. The lack of effective valves causes pressure to build in the vein, which over time weakens the vessel walls and causes the vein to dilate and kink. That is why many people describe varicoceles as a "bag of worms".

Why are varicoceles be a problem?

Many varicoceles are asymptomatic, but varicoceles can cause problems in two ways. First, just like varicose veins in the legs, pressure and congestion in the veins result in an uncomfortable achy feeling, especially when sitting or standing upright. Second, varicoceles cause vascular congestion that can lead to infertility by damaging sperm in the testes. Varicoceles are found in 50% of men presenting with primary infertility and 69% of men with secondary infertility. Fortunately, both of these conditions almost always go away after the varicocele is treated.

What are the treatment options for varicoceles?

Varicoceles may be treated surgically by a urologist (varicocelectomy) or by a minimally invasive method (varicocele embolization) by an Interventional Radiologist. Embolization requires no stitches or general anesthesia and only a tiny nick in the skin. Nearly all the patients can be treated on an outpatient basis and may return to normal activities in two to three days. Surgical treatment requires an incision and may require several days or even weeks to return to full activities. Studies have shown that embolization and surgery are equally effective. Regardless of the treatment, the varicocele may recur and may require repeat treatment. If the varicocele has been previously treated with surgery, embolization is still an option. If recurrence occurs after the embolization, embolization can generally be repeated. If a repeat embolization fails, surgery can still be performed.

What is varicocele embolization?

To treat the varicocele, a doctor known as an interventional radiologist (IR) inserts a small tube, called a catheter, into a vein in upper arm through a tiny nick in the skin. Using imaging guidance, the IR guides the catheter into the abnormal veins above the scrotum that cause the varicocele. These vessels are blocked off by placing a sclerosing solution and/or tiny coils. Just like surgery, the blood then flows out of the scrotum via normal veins with competent valves. When the procedure is over, the catheter is removed and a small bandage is placed over the skin nick in the arm without stitches.

What are the outcomes from embolization?

There is a 90% success rate with embolization, and of those with success, about 10% may experience late recurrence. These results are the same as those achieved with more invasive surgical techniques. Varicocele embolization has been performed for over 25 years and has an excellent long-term safety record. Its safety and effectiveness has been shown in very large trials. Some men have a temporary feeling of pressure in the scrotum for a few days after treatment. Complications from embolization are rare.

What is the alternative to embolization?

The traditional treatment of varicoceles has been surgery. This is performed by exposing the abnormal veins in the leg crease through an incision and tying off the abnormal veins. Some or all of the varicocele itself is often removed. The conventional techniques of surgical varicocele repair have a 5% risk of of hydrocele (fluid) formation, and rare infections or testicular atrophy can occur. Recovery is usually a few days to several weeks.

Does varicocele treatment improve fertility?

Regardless of the technique used, there have been many studies that show repairing a varicocele improves sperm quality and directly increases spontaneous and assisted pregnancy rates, regardless of whether it is treated surgically or non-invasively. Overall, successful varicocele treatment improves semen quality in 70% of patients and improves the pregnancy rate to 40%.

Am I a candidate for varicocele embolization?

The best treatment for a varicocele depends on whether or not you have had prior treatment for a varicocele. You should discuss your treatment options with your doctor. The cost of embolizaiton is similar to surgery. Most insurance companies pay for the procedure, but coverage depends on your particular insurance company.

How can I find out more?

The Society of Interventional Radiology is a good resource for information about varicocele embolization www.sirweb.org. To schedule a consultation with an interventional radiologist at Utah Vascular Clinic, contact us for an appointment.