Currently there are two treatment options for men with varicoceles: Catheter-directed embolization or surgical ligation
Catheter-directed Embolization
Catheter directed embolization is a non-surgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body and is the most common treatment for varicoceles in Europe. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure.
For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin or neck using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so s/he can map out exactly where the problem is and where to embolize, or block, the vein.
By using coils, sclerosants or other materials the interventional radiologist blocks the blood flow in the vein which reduces pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways. Essentially, the incompetent vein is "shut off" internally, accomplishing what the urologist does, but without surgery. Embolization is an out patient procdure and recovery time to routine, non strenuous activity is 1-2 days with full unrestricted activity in 1-2 weeks.
Surgical Treatment of Varicocele
Surgical closure of the vessel, performed by a urologist, is the most common treatment for varicoceles in the USA. The patient receives anesthesia, an incision is made in the skin above the scrotum, cutting down to the testicular veins. The veins are identified and tied off or blocked with sutures. Patients typically leave the hospital the same day and recovery time to routine, non-strenuous activity is typically 2-3 weeks while recovery to full strenuous activity can be as long as 6 weeks.
Embolization vs. Surgery
Embolization is equally effective in improving male infertility and costs about the same as surgical ligation. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy. In one study, sixty percent conceived who were treated for infertility. In another study, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.
Average of one to two days for complete recovery for embolization, compared to two to three weeks for surgery. 24 percent of surgical ligation patients required overnight hospital stay, compared to none for embolization
Varicocele embolization, a nonsurgical treatment performed by an interventional radiologist, is as effective as surgery, as measured by improvement in semen analysis and pregnancy rates. Varicocele embolization involves less risk, less pain and a shorter recovery time as compared with surgical varicocele ligation. A patient with varicoceles on both sides can have them embolized simultaneously through one vein puncture site, compared to surgery, which requires two separate open incisions. Varicocele embolization does not require general anesthesia.
Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor.
