Varicocele
Gonadal Vein Embolization
Varicocele Embolization is an interventional radiology treatment for varicoceles that involves no incision near the genitals. It works by closing off blood flow to the affected vein(s), causing the varicocele to shrink.
What is Varicocele Embolization?
During Varicocele Embolization, a doctor positions a catheter (thin tube) through a small needle puncture in the leg and into the varicocele vein using X-ray guidance. A dye is injected to create an X-ray map (venogram) of the vein and tiny metal coils are inserted through the catheter to block the flow of blood to the vein.
What are Varicocele Symptoms?
How are Varicoceles Diagnosed?
Typical 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.
1.) 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.
2.) Fertility Problems:
There is an association between varicoceles and infertility or subfertility, 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 subfertile 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 50-70 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.
3.) 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, treatment is often recommended. The repaired testicle will return to normal size in many cases.
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 varicocele ultrasound, a noninvasive imaging exam called color 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.
Advantages of the Embolization technique
Recovery from embolization is much faster than invasive surgery because there is no incision to heal or stitches to be removed. The complication rate for Varicocele Embolization is only 0-1%, compared with 1-3% for surgery. Recovery typically takes less than 24 hours and patients often return to work the next day.
Compare that to varicocelectomy, where patients may need to avoid strenuous activity for several days or even weeks. Some complications of varicocelectomy, such as hydrocele (fluid around the testicle) and infection are virtually unheard of after Varicocele Embolization.
For those concerned about fertility, Varicocele Embolization is as effective as surgery (as measured by improvement in semen analysis and pregnancy rates).
