Varicocele Embolization: Procedure, Effectiveness, Risks and Side Effects

close up imaging of varicocele embolization.

What is varicocele embolization?

Varicocele embolization is a medical procedure that redirects blood from a varicocele, which is an enlarged vein in the scrotum. Varicoceles can cause pain and swelling, and can even lead to infertility.

Radiologists perform the procedure by using a small coil or liquid agent to embolize (or close off) the vein. Men who have a varicocele embolization often see an improvement in their symptoms.

Who Should Have Varicocele Embolization?

A varicocele can be described as an abnormal enlargement of veins in the scrotum. These veins are very much like varicose veins that can form in the legs. These vessels may swell when the valves are not functioning properly.

Varicoceles rarely cause any symptoms. However, in some cases varicoceles can slow down the growth of testicles in teenagers. They can also lead to pain, swelling and infertility. Men who experience these symptoms may opt to receive treatment.

The two main forms of treatment are surgery and varicocele embolization. Both options have comparable success rates. However, because embolization only involves using a small needle, the recovery time is usually shorter and it doesn’t require you to be put under general anesthesia.

If you have varicoceles that affect both testicles (bilateral), it might be better to go with surgery. Discuss your options with your healthcare provider to determine which is right for you.

Risks and Side Effects

While varicocele embolization is generally very safe, there are rare instances where the following could occur:

  • Inflammation in the vein or scrotum
  • Infection
  • Excessive bleeding
  • The coil used to block the varicocele may move out of place.
  • Back pain
  • Allergic reaction
  • Nausea

It is possible that the procedure will not work, or that your varicocele will return. Even if your first treatment was successful, it might still return.

Your individual risks could be different. These risks may vary depending on your age and existing health conditions. Your risk can also be affected by the anatomy of your varicocele.

Before you have the procedure, talk to your doctor about any concerns you may have.

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Before The Procedure

How you’ll need to prepare for the procedure will be explained by your doctor. Make sure you tell your healthcare provider about the following:

  • Your medical history
  • If you have history of drug allergies or problems with contrast dye.
  • If you’ve recently experienced any symptoms, such as a fever.
  • If you’re currently taking any medications (this includes OTC medicine, like aspirin).

You should avoid eating or drinking for several hours prior to your procedure. Ensure that someone is able to drive you home after the embolization.

Other tests may be required before you have the procedure (such as an ultrasound of the scrotum) in order to get more information about your varicocele.

Varicocele Embolization Procedure

The varicocele embolization procedure will be explained to you by your healthcare provider. It can take several hours, but generally involves the following:

  • Most likely, you will first receive medication to help you feel drowsy and relaxed.
  • Your heart rate and blood pressure will be closely monitored by medical staff.
  • You will be given a shot of numbing medication to the inner area of your upper thigh. The shot will prevent you from experiencing much sensation during the procedure.
  • The area will be cleaned by your healthcare provider. He or she will insert a needle through a large vein in your inner thigh. A catheter tube will then be inserted into this vein.
  • The doctor will use X-rays to move the tube into the right place in your scrotum. To improve the view of the X-ray imaging, he or she might inject contrast material into the vein.
  • Then surgeon will then place either a small coil or a liquid blocking agent into the affected vein. This causes the blood flow to be diverted to nearby veins, where blood can then flow normally out of the scrotum. The varicocele should disappear if the procedure is successful.
  • The catheter will then be removed and a bandage placed over the entry point on your thigh.

Following The Procedure

After the procedure, you will be closely monitored. Most often you will be able go home the same day. Your doctor will be able to tell you if the procedure was successful.

You will probably need to rest for the remainder of the day, but you should be able go about your usual daily activities by the following day. You shouldn’t drive, or make important decisions if you have taken medication to relax.

You will probably need more time before engaging in exercise or other strenuous activities. Additionally, you may need to refrain from sexual activity for a number of weeks.

If you experience any complications after the procedure, such as redness or inflammation, it’s important to let your healthcare provider know.

You will need to schedule a follow-up appointment with your doctor after the procedure. A semen analysis may be necessary if you are experiencing fertility problems. This can help determine if your fertility is improving. If your varicocele returns, you may need to have another embolization or surgery.

Frequently Asked Questions

How Painful Is Varicocele Embolization?

There is little pain during the procedure. The doctor might offer a local anesthetic and/or mild sedation. Some men opt for neither anesthesia or sedation and do fine.

How successful Is Varicocele Embolization?

Embolization has a 90% success rate. 10% of those who have had success may experience a return of the varicocele, but these results are comparable to those seen with more invasive surgical procedures. Varicocele embolization is a long-standing procedure that has been used for more than 25 years. It has an excellent record of safety.

Is Varicocele Embolization Better Than Surgery?

There seems to be higher risks associated with surgical repair compared to varicocele embolization, and there is no significant advantage to surgery when it comes to success rates. This suggests that embolization might be a better option for treating varicoceles in infertile men.

Does Varicocele Embolization Increase Sperm Count?

The rate of pregnancy is nearly 50% after varicocele embolization. This is due to an increase in sperm count and motility. You should consult an interventional radiologist specializing in varicocele treatment if you are interested in having varicocele embolization rather than surgery.

Can A Varicocele Return After Embolization?

Varicoceles return in approximately 5-10% of men following varicocele embolization. However, these varicocele recurrence rates are similar to those following more invasive surgical procedures.

How Long Until A Varicocele Goes Away After Embolization?

The time it takes for a varicocele to disappear after embolization can vary from a few days, to weeks, or even months. For instance, some men may only need one or two days for recovery, and the swollen veins go away quickly. In others, the swollen veins may still be visible following surgery and take longer than usual to disappear completely.

Keep in mind that the swollen veins are blocked off and the blood flow is redirected, so they are not removed from the scrotum. Therefore you will still be able to see the affected veins even after surgery. However, they will no longer be connected to the other veins in the scrotum in order to improve sperm production or relieve pain and swelling.

Can Varicocele Embolization Cause Erectile Dysfunction?

Varicocele embolization does not negatively impact sexual function. In fact, research suggests that having a varicocele repaired might actually improve sexual function.

Is Varicocele Embolization Expensive?

The cost is similar to surgery, as most insurance companies pay for the procedure. The rates generally range from approximately $3000 to $8000. Embolization can sometimes be more expensive than surgery since it involves the working with major blood vessels and the patient is subject to unique complications.

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