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What is Varicocele Embolization?

Varicocele Embolization is a minimally-invasive IR procedure used to treat the development of varicose veins next to the testicles. This condition affects approximately 10% of all men. Typical symptoms of these swollen veins are usually mild and may not require treatment, but occasionally they can cause pain, fertility problems, and atrophy (shrinkage) of the testicles.


In healthy veins, one-way valves keep the blood flowing the right direction – from the testicles and scrotum back to the heart. But in a varicocele, the valves malfunction and become “leaky,” allowing blood to flow in the reverse direction, which causes the affected veins to become enlarged.

One of the most common symptoms of varicoceles is an aching pain, often felt when standing or sitting for an extended time, allowing pressure to build up in the swollen veins. This pain is sometimes brought on or made worse by lifting heavy objects.

Another symptom of varicoceles can be infertility or subfertility. Although no direct cause-and-effect relationship has been proved, one study found that 40% of men who were subfertile had varicoceles. Other studies have found that the presence of varicoceles can be linked to decreased sperm count, decreased sperm motility, and an increase in the number of deformed sperm. The mechanics of this link have not been determined, but one theory is that the varicoceles raise the temperature of the testicles and thus hinder sperm production. Some studies have shown that men with fertility problems often see an improvement in sperm quality and quantity after treatment to repair the varicoceles. As a third symptom, untreated varicoceles can result in impaired blood flow and the shrinking or atrophy of one or both testicles.

Varicoceles are often diagnosed during a physical examination, because the presence of the swollen veins can make the scrotum appear lumpy. A suspected diagnosis of varicoceles can be verified via noninvasive imaging such as color flow ultrasound.

Traditional treatment of varicoceles has usually involved invasive surgery, which involves general anesthesia, incisions and stitches, and often a long and painful recovery period. Varicocele Embolization provides a minimally-invasive varicocele treatment that is as effective as surgery, but with less risk, less pain, and much less recovery time.

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What To Expect

The Varicocele Embolization procedure is a straight-forward outpatient procedure. During the procedure, the interventional radiologist inserts a catheter into a tiny incision in the jugular vein in the neck. The catheter is then guided using X-ray to the damaged veins. Once the vein to the varicoceal is identified, small coils or sclerosing agents are used to block off the blood flow from the vein.


Results

After a short stay in the recovery area, patients usually return home the same day. You may be advised to avoid strenuous activity for 24 hours, but most patients return to their full activities in a day or two. There is no effect on sexual function.

Studies have shown that Varicocele Embolization can improve semen analysis. And although there is no 100% guarantee, some studies have shown that pregnancy rates improve after varicocele repair by 30%-50%.

A Few Of Our Cases

Image A
This image deominstrates the left sided gonadal vein (on the right side of the image) has already been embolized with a series of small coils. The coils permanently block the blood flow in the gonadal vein preventing the blood from flowing in the wrong direction. The catheter in this image is seen selecting the right gonadal vein ( on the left side of the image). Contrast is noted in the vein just prior to the emoblization procedure.
Image B
This image shows both the right and left gonadal arteries have been blocked with small metal coils to prevent blood flowing in the wrong direction.
Image C
This is an image from a color Doppler US of the testicular varicocele. The blue and red colors represent the blood going in multiple different directions and is very characteristic of varicoceles. The abnormal collection of veins in the scrotum can cause pain and infertility. Physical exam and Doppler US are accepted methods for diagnosis.