Surgery For Varicocele Is No Longer Required

If you have been diagnosed with a varicocele, you have more treatment options than you may have been told about. A revolutionary newer procedure called varicocele embolization is a non-surgical alternative to painful varicocele surgery.
Varicocele embolization has been successful at eliminating varicoceles for thousands of men, and can have you back to your active lifestyle in only a few days. Many men choose this non-surgical alternative because it does not involve general anesthesia, incisions in the scrotum, or sutures.

What Is a Varicocele?
Varicoceles are a relatively common condition (affecting approximately 10 percent of men) that tends to occur in young men, usually during the second or third decade of life. Sometimes, these varicoceles cause no symptoms and are harmless. But sometimes a varicocele causes pain or atrophy (shrinkage), or fertility problems.
Normally, blood flows to the testicles through an artery, and flows out via a network of tiny veins that drain into a long vein that goes up through the abdomen. The direction of blood flow in this vein should always be up, toward the heart. A series of one-way valves in the vein prevent the reverse flow of blood back to the testicles.

What Causes Varicoceles?
These one-way valves sometimes fail. The reverse flow of blood stretches and enlarges the tiny veins around the testicle to cause a varicocele, a tangled network of blood vessels, or varicose veins (see Figure).

Varicocele Symptoms
Typical varicocele symptoms are mild and many do not require treatment. Treatment may be necessary if the varicocele is causing discomfort or any of the other problems listed below.

Signs & symptoms of Varicoceles

Pain
One of the signs of varicoceles is an aching pain when the individual has been standing or sitting for an extended time and pressure builds up in the affected veins. Heavy lifting may make varicocele symptoms worse and, in some cases, can even cause varicoceles to form. Usually (but not always) painful varicoceles are prominent in size.

Fertility Problems
There is an association between varicoceles and infertility or sub fertility, but it is difficult to be certain if a varicocele is the cause of fertility problems in any one case. In one study, as many as 40 percent of men who were sub fertile were found to have a varicocele. Other signs of varicoceles can be a decreased sperm count; decreased motility, or movement, of sperm; and an increase in the number of deformed sperm. It is not known for sure how varicoceles contribute to these problems, but a common theory is that the condition raises the temperature of the testicles and affects sperm production. Studies have shown that from 50 percent to 70 percent of men with fertility problems will have a significant improvement in the quality and/or quantity of sperm production after they have undergone varicocele repair.

Testicular Atrophy
Atrophy, or shrinking, of the testicles is another of the signs of varicoceles. The condition is often diagnosed in adolescent boys during a sports physical exam. When the affected testicle is smaller than the other, repair of the variocele is often recommended. The repaired testicle will return to normal size in many cases.

Diagnosis
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" (see Figure below).
When varicocele symptoms are not clearly present, the abnormal flow of blood can often be detected with a noninvasive imaging exam called color flow doppler 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.

A color flow ultrasound image of a prominent varicocele. A large varicocele may make the scrotum look lumpy so it resembles "a bag of worms"

Varicocele Treatment Options

In INDIA and other parts of the world, varicocele treatment has traditionally involved open surgery, usually performed by a urologic surgeon, or general surgeon. In recent years, however, a safe and effective nonsurgical alternative called varicocele embolization is becoming the treatment of choice for many patients and their physicians.

1. Surgical Treatment

Varicocele Surgery

Varicocele Surgery is usually performed under general anesthesia. Occasionally, the surgery is performed with a local anesthetic. In this type of varicocele treatment, the surgeon makes an incision above the scrotum (or higher in the flank area) and cuts through the layers of tissue to expose the veins (see Figure).

 

The affected veins are ligated, or tied off, to detour the flow of blood into normal veins. Sometimes a laparoscope (a cylindrical metal scope inserted into the abdomen) is used to perform the surgery. Recovery time depends on the type of surgery, but most patients require up to six weeks before heavy lifting and other strenuous activities can be performed. Light activities may be resumed more quickly.

2. Non-Surgical Treatment

Varicocele Embolization

Non-surgical catheter directed embolization is an outpatient treatment. Specifically trained interventional radiologist makes a tiny nick in the skin at the groin or neck using local anesthesia and a thin catheter is passed and directed to the testicular vein. With contrast dye injection, interventional radiologist map out exactly where the problem is and by using coils, by embolization, blood flow is re-directed to other healthy pathways. Whole non-surgical treatment procedure is pain less and takes about 30 minutes. The tube is removed and no stitches are needed. Patients are observed for a few hours and go home the same day. Recovery from varicocele embolization typically takes less than 24 hours and patients often return to work the next day.

Varicocele Embolization is effective in improving male infertility and costs about the same as surgical ligation. The study shows, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated.

Advantages of Varicocele Embolization
The majority of men in INDIA undergo surgery as varicocele treatment. This is because they are usually sent to surgeons for evaluation, and many do not know about varicocele embolization.

• It is more effective than surgery, as measured by improvement in pain, semen analysis and pregnancy rates.
• It does not require any surgical incision in the scrotal area.
• A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions)
• General anesthesia is not used for embolization (most surgery is done under general).
• There is a lower rate of complications compared to surgery. Infection has not been reported after embolization.
• It requires less recovery time. Post embolization patients are virtually never admitted to the hospital. Even patients with physically demanding jobs may return to work within the next day or two, unlike post surgical patients.