Varicocele Treatments
The two mainstays of treatment for varicoceles include:
Surgical therapy for varicoceles
Open surgical ligation, performed by a urologist, is the most common
treatment for symptomatic varicoceles. Surgical therapy involves
ligating or tieing off all abnormal veins that drain the testicle to
help restore normal blood flow. Our microsurgically-trained experts
perform this surgery routinely. An operating microscope is utilized to
help aid in the precise identification of veins so as to maximize
efficacy and minimize complications. Although patients leave the
hospital the same day, there is a two- to three-week recovery period.
Radiologic therapy for varicoceles
Radiologic therapy by catheter directed embolization involves
puncturing a large vein in the groin and then clogging off the
offending scrotal veins. While only a small puncture is required, the
recurrence rates can be high.
Catheter directed embolization is a non-surgical, outpatient
treatment performed by an interventional radiologist using imaging to
guide catheters or other instruments inside the body. Through mild IV
sedation and local anesthesia, patients are relaxed and pain-free
during the approximately two-hour procedure.
For the procedure, an interventional radiologist makes a tiny nick
in the skin at the groin using local anesthesia, through which a thin
catheter (much like a piece of spaghetti) is passed into the femoral
vein, directly to the testicular vein. The physician then injects
contrast dye to provide direct visualization of the veins so s/he can
map out exactly where the problem is and where to embolize, or block,
the vein. By using coils, balloons, or particles, the interventional
radiologist blocks the blood flow in the vein which reduces pressure
on the varicocele. By embolizing the vein, blood flow is re-directed
to other healthy pathways. Essentially, the incompetent vein is
"shut off" internally by preventing blood flow,
accomplishing what the urologist does, but without surgery.
Recovery time for radiologic treatment of varicoceles
- Average of one to two days for complete recovery for
embolization, compared to two to three weeks for surgery
- 24
percent of surgical ligation patients required overnight hospital
stay, compared to none for embolization
Benefits of interventional radiology treatment for varicoceles
- No surgical incision in the scrotal area, no general
anesthesia, no sutures, no infections
- Effective as surgery,
as measured by improvement in semen analysis and pregnancy
rates
- Less recovery time so patients are able to return to
normal daily activities immediately and without hospital
admittance
- A patient with varicoceles on both sides can have
them fixed simultaneously through one vein puncture site, compared
to surgery, which requires two separate open incisions
- Cost-effective
Efficacy of embolization for varicoceles
Embolization is equally effective in improving male infertility and
costs about the same as surgical ligation. Pregnancy rates and
recurrence rates are comparable to those following surgical
varicocelectomy. In one study, sixty percent conceived who were
treated for infertility.
In another study, sperm concentration improved in 83 percent of
patients undergoing embolization compared to 63 percent of those
surgically ligated. Patients who underwent both procedures expressed a
strong preference for embolization.