Varicocele embolization and varicocele surgery have the same success rate but embolization is quicker, shorter, less painful, easier, and safer.
A varicocele is a varicose vein of the testicle and scrotum that may cause pain and lead to testicular atrophy (shrinkage of the testicles). In healthy veins within the scrotum, one-way valves allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele. Some experts believe that the raised temperature that results from the pooled blood in these dysfunctional veins can decrease sperm count and motility of sperm and increase the number of deformed sperm. In fact, the incidence of varicoceles increases to 30 percent in couples who cannot have children.
Approximately 10 percent of all men have varicoceles.
Among infertile couples, 30 percent of men have varicoceles.
The highest occurrence of varicoceles is in men ages 15–35.
80,000–100,000 men in America may undergo surgical correction of varicoceles each year.
- Pain: Men who experience pain in their testicles—particularly when exercising, standing or sitting for a long period of time—may be suffering from varicoceles. Typically, painful varicoceles are prominent in size. If left untreated, varicoceles may lead to infertility.
- Fertility problems: There is an association between varicoceles and infertility. Decreased sperm count, decreased motility of sperm and an increase in the number of deformed sperm are related to varicoceles. Some experts believe these blocked and enlarged veins around the testes cause infertility by raising the temperature in the scrotum and decreasing sperm production.
- Testicular atrophy: The shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired, it will return to normal size.
Open surgical ligation, performed by a urologist, is a common treatment for symptomatic varicoceles. Performed by a urologist, an incision is made in the skin above the scrotum down to the testicular veins, which are tied off with sutures. Although most patients leave the hospital the same day, 24 percent of surgical ligation patients are required to stay at the hospital overnight. Patients of open surgical ligation can expect a two- to three-week recovery period.
A nonsurgical, minimally-invasive, treatment performed by an interventional radiologist. Varicocele embolization closes off the blood flow to the affected vein without surgery. Embolization is as effective as surgery with less risk, less pain and less recovery time. Patients considering surgical treatment should get a second opinion from an interventional radiologist to ensure they know all of their treatment options.
An interventional radiologist uses ultrasound guidance to insert a thin catheter into either a vein in your groin or neck after you are sedated. Using live x-rays to ensure technical success, a small catheter is guided into the gonadal vein that supplies the varicocele. The vein is embolized, i.e. permanently closed off, using coils or sclerosing agents, effectively "shutting off" blood flow to the varicocele. The patient is relaxed and free of pain throughout the procedure, which takes approximately 1-2 hours.
Embolization and surgey have both been shown to be effective treatments for men with varicoceles, but there are a number of advantages to embolization:
- Minimally invasive outpatient procedure
- No general anesthesia
- No incision into the testicle, scrotum, or abdomen
- No sutures
- Preferred option if you’re experiencing pain, as surgery can result in additional pain and scarring.
- Preferred option if you’ve already had surgery, and the varicocele came back.
- Short recovery time
- 90% success rates, similar to surgical techniques
- Similar improvements in semen quality and pain relief as surgery
- Reduced risk of infection compared to surgery
- No risk of arterial injury or testicular loss
For more information, or to schedule a procedure, please call (513) 891-7231 to request a consultation with Dr. Dorio or a member of his team of experienced interventional radiologists.