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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. Varicoceles are a relatively common condition affecting approximately 10-15 percent of all men between the ages of 15 and 35 years old.
 
WHAT ARE THE SYMPTOMS FOR VARICOCELE?
Most varicoceles cause no symptoms and are harmless. But sometimes a varicocele can cause pain or shrinkage of the testicles or fertility problems. 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.
 
HOW DO YOU PREPARE FOR VARICOCELE EMBOLIZATION AND WHAT IS IT LIKE?
The evening before the exam you may not eat or drink anything. You will be instructed which medications you may take in the morning, and when to arrive at the hospital. After registering at the hospital, you will be sent to the Special Procedures Area (SPA), where you will have an intravenous (IV) line placed in your arm. Fluids, antibiotics and anti-nausea medications will be given prior to your procedure. You will then be sent to the Interventional Angiography Suite in the Department of Radiology. Here you will meet doctors (Interventional Radiologist) and nurses/technologist trained in this procedure. You will be given sedation for relaxation and pain, but you will be conscious during the procedure.
 
First the Radiologist will perform a venogram. A thin tube (catheter) is inserted through a small nick in the skin and threaded through the testicular vein into the scrotum. An x-ray liquid (contrast) is injected to show the abnormal veins. Then tiny coils made of stainless steel or platinum, balloons, or other materials are inserted in the vein to block it and stop the backflow, or pressure, in the varicocele. Blood can still exit the testicle through other normal pathways. Once it is confirmed that there is no flow in the affected vein, the catheter is removed. Once the procedure is completed you will be sent back to SPA for a 2-hour recovery, at which time you will be discharged to home.
 
WHAT ARE THE EFFECTS AND COMPLICATIONS?
Following the procedure you will be asked to avoid heavy lifting for two weeks. Otherwise, recovery from varicocele embolization typically takes less than 24 hours and many patients return to work the next day. Minor complications such as bruising at the entry site, mild backache, or nausea (rare) may occur. Complications associated with surgery such as hydrocele (collection of fluid in the testes), infection, or loss of testicle is exceedingly rare with an embolization procedure.
 
WILL EMBOLIZATION OF A VARICOCELE HELP MY SYMPTOMS?
For patients complaining of pain before the procedure, there is significant relief of symptoms 80-90% of the time. If the procedure is not successful it is often due to variations in venous anatomy that make the procedure impossible to perform from a technical standpoint. For patients with complaints of infertility, sperm count and sperm function will significantly improve after successful embolization. Pregnancy rates in infertile couples improve after varicocele repair by about 30-50%. Varicocele embolization does not affect sexual function. Sexual activity may be resumed the day after the embolization. However, since it takes sperm about three months to mature, improvement in fertility may take three months or longer.

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