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Men's Health Topics Varicocele Embolization By Hope Waltman Hundreds of thousands of men in the United States undergo surgical treatment for varicocele. Fifteen percent of varicoceles occur at birth in North America. Varicocele is the leading cause for male infertility. Many are never aware that there is a less-invasive option for treatment, varicocele embolization. What is a varicocele? Varicoceles are dilated blood vessels (varicose veins) in the scrotum. Blood from the testicle drains into a collection of tiny veins, which join and empty into a vein that goes through the abdomen. Normally, the blood should always flow in the direction of the heart. This directional flow is ensured by valves inside the veins. When the valves fail, blood flow can reverse (venous reflux) and the tiny veins enlarge and can become bothersome to the patient. What are the symptoms for varicocele? Varicoceles can cause pain and shrinkage of the testicles. A man may experience an aching pain if he has been standing or sitting for a long period of time because of the pressure in the varicose vein. Heavy lifting can irritate the varicocele or even help in creating a varicocele. For a large varicocele, the scrotum may look like a lumpy “bag of worms”. Varicoceles can cause infertility because they interfere with regulation of the temperature of the testicles. What age does varicocele disease affect men? The condition affects approximately 10-15 percent of all men between the ages of 15 and 35 years old. Should all varicoceles be repaired? No. The varicocele should only be treated if it becomes symptomatic (pain, shrinkage of testicles, infertility). What are the advantages of Varicocele Embolization versus varicocele open surgery? A urologic surgeon or urologist performs varicocele
open surgery. Surgery requires an incision in the scrotum and cuts
through layers of tissue to expose the veins. Abnormal veins are
ligated, or tied off, which detours the blood to normal veins.
Sometimes a laparoscope is used. What is the timeframe for recovery with Varicocele Embolization versus varicocele open surgery? Patients who have the embolization procedure performed return to work 2 days compared to 6 days with surgery. Embolization patients resume full activities in 4-5 days compared to 21 days with surgery. I asked Dr. Robert Worthington-Kirsch, an Interventional Radiologist, to describe the Varicocele Embolization treatment. "I first set-up a consultation to get the patient’s history, discuss all aspects of the procedure, answer the patients questions, and look at the non-invasive color flow ultrasound study (the ultrasound is done while the patient is standing and takes 20 minutes). The Varicocele Embolization procedure takes approximately 1-˝ hours to perform. The day of the procedure, the patient will be admitted in the Outpatient Day Surgery unit. A light sedation will be administered intravenously and local anesthetic is used to numb the puncture site. The Interventional Radiologists makes a small nick in the skin (about the size of a pencil lead) and a small tube (catheter) will be inserted in the groin (leg) or sometimes in the right side of the neck. The doctor guides the small catheter painlessly into the abdomen and into the venous system to the scrotum under the guidance of x-ray imaging. A dye is injected and creates an x-ray map (venogram) of the vein. Tiny stainless steel metal coils and gelatin sponge slurry are inserted through the catheter to block the abnormal blood flow. The catheter is removed and no stitches are needed. The patient stays in the recovery room for a few hours for observation and goes home the same day. The recovery for this procedure is typically less than 24 hours and most patients return to work the next day." Does Varicocele Embolization affect semen analysis? Studies show embolization can improve semen analysis, but there is no guarantee to any patient that they will experience this. Varicocele Embolization does not affect sexual function. Pregnancy rate studies for infertile couples show an improvement of approximately 60 percent after having embolization performed. What is the success rate for Varicocele Embolization? The success rate is 80-90 percent. Varicocele Embolization appears to be a very safe technique that yields impressive results over the existing varicocele open surgery treatments. E-mail questions: My 11 year old son has just been diagnosed with a varicocele in his left testicle. He complains nightly of pain. Both of his testicles are equal in size at this point. We have been told to watch and wait six months to have him rechecked. Motrin and Aleve are not helping with his discomfort. What else can I try? He should be evaluated by a pediatric urologist. Varicocele in someone that young is extremely unusual and needs further work-up. - Robert Worthington-Kirsch, M.D. ***** Hi. I recently had catheter directed embolization performed. When should I start to see the varicose vein on my testicle shrink...is it days or weeks? - England Over a few weeks is typical. - Robert Worthington-Kirsch, M.D. ***** Do varicose veins in the scrotum effect proper/ sufficient blood flow, and affect sexual stamina? Also would surgery or embolization help return normal blood flow?
Varicose veins of the scrotum (called
varicocele) can cause pain and discomfort, but do not usually have an
effect on sexual performance. They may be a cause of inadequate heat
exchange, leading to abnormally high testicular temperatures and
inadequate sperm function. In this manner they can contribute to
male factor infertility.
Historically varicoceles can be
treated when they are painful or as a therapy for infertility. Both
embolization and surgery are done. Embolotherapy is generally
considered to be more reliable. - Robert Worthington-Kirsch, M.D.
***** I have been diagnosed with a varicocele. Can you tell me if heavy lifting would contribute to this? Heavy lifting, or anything that raises intra-abdominal pressure, can worsen varicoceles. It probably cannot cause them (they are most likely congenital). – Robert Worthington-Kirsch, M.D. Note:
www.sirweb.org has a "Find an Interventional Radiologist who performs Varicocele Embolization (search - Male infertility)". Reprinted by permission of Hope Waltman, Founder of Hope For Fibroids Organization, (web site) www.hopeforfibroids.org, (e-mail) hopewaltman@paonline.com.
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