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Treatment Options

 
In the United States, varicocele treatment has traditionally involved open surgery, usually performed by a urologic surgeon, or urologist. In recent years, however, a safe and effective nonsurgical alternative called varicocele embolization is becoming the treatment of choice for many patients and their physicians.

Varicocele Surgery

Varicocele Surgery is usually performed under general anesthesia in an outpatient setting. Occasionally, the surgery is performed with a local anesthetic.

In this type of varicocele treatment, the surgeon makes an incision above the scrotum (or higher in the flank area) and cuts through the layers of tissue to expose the veins (see Figure 3).

All Varicocele Pictures on this site copyright John Yesko, 2001

The affected veins are ligated, or tied off, to detour the flow of blood into normal veins. Sometimes a laparoscope (a cylindrical metal scope inserted into the abdomen) is used to perform the surgery. Recovery time depends on the type of surgery, but most patients require up to six weeks before heavy lifting and other strenuous activities can be performed. Light activities may be resumed more quickly.


Varicocele Embolization

Click to see an animation of the varicocele embolization procedure.

Varicocele embolization is an outpatient procedure that is performed without general anesthesia using “twilight” sedation. In this type of varicocele treatment, a small tube is inserted into the groin through a small nick in the skin (about the size of the lead in a pencil). Sometimes the tube is put in through a vein in the right side of the neck. The skin is numbed for this procedure and it is not painful. Next, a small catheter, or tube, is painlessly guided up into the abdomen and into the varicocele vein under the guidance of x-ray imaging (see Figure 4).

All Varicocele Pictures on this site copyright John Yesko, 2001

A dye is injected to create an x-ray map (venogram) of the vein and tiny metal coils or other embolizing substances are inserted through the catheter to block the flow of blood to the vein (see Figure 5).

All Varicocele Pictures on this site copyright John Yesko, 2001

The tube is removed and no stitches are needed. Patients are observed for a few hours and go home the same day. Recovery from varicocele embolization typically takes less than 24 hours and patients often return to work the next day.


Advantages of Varicocele Embolization

The majority of men in the United States undergo surgery as varicocele treatment. This is because they are usually sent to surgeons for evaluation, and many do not know about varicocele embolization.

The advantages of this alternative, interventional radiology varicocele treatment include:

  • It is as effective as surgery, as measured by improvement in pain, semen analysis and pregnancy rates.
  • It does not require any surgical incision in the scrotal area.
  • A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions)
  • General anesthesia is not used for embolization (most surgery is done under general).
  • There is a lower rate of complications compared to surgery. Infection has not been reported after embolization.
  • It requires less recovery time. Post embolization patients are virtually never admitted to the hospital (in one study 24% of surgical patients needed hospital admissions, but no embolization patient did). Even patients with physically demanding jobs may return to work within the next day or two, unlike post surgical patients.

To view a list of scientific papers comparing surgery and embolization see references 1-6 in the References section.