A. A Varicocele is a network of tangled and dilated blood vessels (varicose veins) in the scrotum. It is a leading cause of male infertility and may also cause pain and atrophy (shrinkage) of the testicles.
Q. How varicocele is diagnosed?
A. Sometimes a varicocele can be diagnosed during a physical examination. A large varicocele may make the scrotum look lumpy so it resembles "a bag of worms"
When varicocele symptoms are not clearly present, the abnormal flow of blood can often be detected with a noninvasive imaging exam called color Doppler (flow ultrasound). Varicoceles also may be detected with a venogram - an x-ray in which a special dye is injected into the veins to "highlight" blood vessel abnormalities.
Q. What are the advantages of varicocele embolization versus varicocele surgery?
A. Unlike varicocele surgery, embolization requires no incision, stitches, or general anesthesia. Embolization patients almost never require overnight admission to the hospital. Several studies have shown that embolization is even more effective than surgery. Embolization patients return to full activities in a day or two, but varicocele surgery patients may need to avoid strenuous activity for several days or even weeks. Some complications of varicocele surgery, such as hydrocele (fluid around that testicle) and infection are virtually unheard of after embolization.
| NON-SURGICAL - EMBOLIZATION | SURGICAL |
| No, Local anesthesia only | Need General anesthesia |
| Need just 4 hrs hospital stay | Require an overnight stay |
| Recovery-Within 24 hrs | 2-3 Weeks |
| Pain-Very little. | Yes. To be managed with Tab / injection analgesia |
| Scar - No | Yes - depending on surgical technique. |
Q. Should all varicoceles be repaired?
A. Not necessarily. If you have symptoms, such as pain, you may choose to have a varicocele repair procedure sooner. But an asymptomatic varicocele is a common condition that does not necessarily cause pain or infertility. A varicocele only needs to be fixed when it causes pain, shrinkage of a testicle, or when it is associated with male infertility.
Q. Will varicocele embolization (Non-surgical treatment) improve my semen analysis?
A. Many studies have shown that varicocele repair can improve semen analysis significantly, but there is no guarantee that all individual patients will experience a significant improvement. Pregnancy rates in infertile couples improve after varicocele repair by about over 30-50%.
Q. Will the varicocele repair procedure reduce my pain?
A. Successful varicocele repair reduces the swelling and discomfort of symptomatic varicoceles. There are other causes of scrotal pain that may need to be ruled out before varicocele treatment.
Q. What are the risks or complications of the procedure?
A. Minor complications such as bruising at the catheter site, nausea or low-grade backache may occur, but are uncommon.
A. The procedure is performed with local anesthesia and "twilight" sedation. It is not a painful procedure. In one study, patients who underwent both varicocele surgery and embolization for varicocele repair, overwhelmingly favored embolization.
Q. How long will I be in the hospital?
A. Typically, patients are observed for a few hours and go home the same day.
Q. What are my restrictions after the procedure?
A. Patients are instructed to rest quietly at home on the day of the embolization procedure. They may resume normal activity the next day. Varicocele surgery often has a longer recovery time.
A. While every patient is different, recovery from varicocele embolization typically takes less than 24 hours and many patients return to work the next day.
Q. Will the procedure affect sexual function?
A. No.
Q. Is there a chance that the varicocele will recur after varicocele repair?
A. There is a 2-5% chance that a varicocele could recur after embolization. But chances of recurrence after surgery are even high.
Q. I had varicocele surgery but my varicocele has come back. Can varicocele embolization help me?
A. Yes. Embolization is a highly effective way to repair varicocele after varicocele surgery.
Q. What does varicocele embolization cost?
A. The cost is generally comparable to varicocele surgery. However, the cost varies depending on grading of varicocele. You should contact interventional radiologist to discuss the cost in detail.
Q. Will my insurance pay for varicocele embolization?
A. Generally, insurance companies will pay for the varicocele embolization. However, some insurance companies limit the coverage provided for infertility treatment. Check with you insurance company about this policy.
Q. If x-rays are used to guide varicocele embolization, is there a danger of radiation exposure?
A. Although the radiologist guides the catheter with an x-ray machine during embolization, the amount of radiation exposure is very low - about equal to the amount received during a chest x-ray.
A. During varicocele embolization, no incision is made in or near the testicles. Rather, a tiny nick is made in the leg or neck to insert a catheter (a small tube). Next, the catheter is guided up to the abdomen and into the varicocele vein. After the procedure, the catheter is removed and no stitches are needed.