Varicocoele Embolization: Frequently Asked Questions Information compiled for patients and their relatives by Dr Eisen Y Liang
What is varicocele?
A varicocele is a network of dilated veins of the testicle in the scrotum. It may causes pain, shrinkage of testis and infertility. The increased temperature in the scrotum may decrease sperm production. It is the most common correctable cause of male infertility.
How is varicocele formed?
It is due to the faulty valves in the testicular vein which drains the testicles up to the level of the kidneys. The faulty valves allow reflux (backflow) of blood and build up of back pressure in the veins.
How can varicocele be treated?
Traditionally it is treated in an operating theatre with surgical ligation. The surgeon makes an incision above the scrotum, cuts through the layer of tissues to expose the faulty veins which are tied off, redirecting veinous return via other healthy pathways. Alternatively, it can be treated by embolization. This is a non-surgical minimally invasive technique. The faulty testicular vein is blocked internally via a catheter 1-2mm in diameter.
How effective are these treatments?
The success rate is above 90% for both surgery and embolization. Improved sperm count and motility were shown in 75% of patients. Subsequent pregnancy rate varies between 30-60% after treatment.
The recurrence rate is around 10% for both treatment. Surgical failure can be treated by embolization and vice versa. Embolization failure can be treated by repeating embolization.
What are the advantages of varicocele embolization compare with surgery?
There is no incisions or stitches and therefore not as painful afterward. There is no need for general anaethetics. After embolization you may resume normal activity in 1-2 days; after surgery, your are required to keep the wound dry and avoid strenuous activities until the wound is healed, that may take 2-6weeks. If you had varicocele on left and right sides, you will need two surgical incisions, whilst embolization of both sides can be performed via a single skin entry less than an few millimeters. Hydrocele (fluid build up around testis), infection and loss of testis are potential surgical complications that are almost unheard of with embolization. Embolization for varicele has been performed over 25 years, its safety and effectiveness have been shown in many studies.
How is the embolisation performed?
It is performed by an interventional radiologist in an angiography suite as an out-patient or day procedure. A light sedation is given. The skin is numbed by local anaesthesia. Either the jugular vein in the neck or femoral vein in the groin can be used as access. A nick in the skin less than 0.5cm is made. A catheter is directed to the testicular vein under X-ray guidance. Small amount of contrast (X-ray dye) is injected to confirm position. Stainless steel or platinum coils are used to block the faulty vein. Sometimes sclerosing agent is also used to reduce the chance of recurrence. The procedure is usually about one hour, longer if there were collaterals need to be treated.
What happen after the procedure?
You will be resting in the recovery for 1-2 hours until the sedation wears off. You need to arrange transport as you are not allowed to drive after the sedation. When you get home you should take it easy. Drink plenty of fluid. Normal activity can be resumed the following day. The dressing should be kept dry for two days and removed afterwards. You may shower as long as you can keep the dressing dry. We would like to see you in a month for a follow-up consultation and ultrasound study. You should also see your urologist for further follow-up. Sperm count can be performed after three months.
Are there any complications with embolization?
Minor complications although uncommon may occur such as bruising at the entry site, mild back ache and nausea. Transient swelling and pain of the scrotum may occur. Thrombosis of the veins inside the scrotum occurs in 2%. Loss of coils in the lungs are very rare and usually has no significant consequence.
Should I be concerned about radiation?
The testes are outside of the radiation field for testicular vein embolization. The gonadal dose and hereditary effect is very low. Who are interventional radiologists?
They are doctors subspecialized in using catheter based devices to treat disease using imaging guidance such as X-ray, CT and ultrasound.
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