Varicocele is a condition causing varicose type enlarged veins in the scrotum. It commonly affects young male patients and can cause a dull dragging type pain or can be a factor in reduced fertility for those wishing to conceive. It can also impair normal testicular development in adolescents.
It is normally diagnosed either by a doctor examining the scrotum or by ultrasound scan. For patients troubled by their varicocele, the treatment options include surgery or embolisation. There are some circumstances that favour one treatment over another and discussion with an interventional radiologist or urologist can help to come to a decision regarding the choice of treatment.
“Embolisation” means closure of blood vessels, in this case the abnormal veins in the scrotum. Embolisation is performed via a needle hole in the leg vein using fine tubes (catheters) which are directed into the abnormal vessels. Metallic coils or medications are used to close the veins.
Varicocele embolisation is performed in a radiology x ray suite as a day stay procedure and takes approx 90mins. Local anaesthetic is normally all that is needed and after a small injection of local anaesthesia there is normally minimal discomfort associated with the procedure.
A thin plastic tube (catheter) is placed into the leg vein and guided under x ray into the veins that supply the varicocele. Venograms (roadmap images) are then taken which show the veins and confirm whether there is abnormal flow into the veins of the scrotum which indicate that embolisation should be performed. You will be asked to hold you breath for a few seconds as the xray images are taken.
Embolisation is performed by advancing a small plastic tube into the vein supplying the varicocele. A combination of metallic coils or medications are used to close off the abnormal veins. Coils are soft and inert and designed to stay in place for life to block the vein. Medications can also be given to further irritate the veins and encourage closure. Some people feel mild discomfort during this step for which painkillers can be given if necessary.
Light pressure will be required for up to 10 minutes on the leg vein after the procedure is completed and you will be asked to lie down for 2-4 hrs afterwards to reduce the risk of bruising. You should also refrain from sport and heavy lifting for 48 hrs and if you have received any painkillers or sedatives you cannot drive legally for 24 hrs. Recovery is normally short with a return to work/studies the next day or in a couple of days if your job includes heavy manual labour.
What are the risks?
Varicocele embolisation is overall a very safe procedure but does carry some risks and complications that may occur.
At the site where the catheter is placed into the vein, you may develop a small bruise called a hematoma, which may take a week or two to resolve.
A few patients will experience mild discomfort in the groin or scrotum after the treatment which rarely lasts more than a few days.
There is a very small risk of a coil, used to occlude a vein, could migrate to you lungs. In the rare event this occurs and it cannot be retrieved, it is very unlikely to result in any problems other than a a cough or mild chest pain for a few days.
Rarely, it may not be possible to obtain a satisfactory position for embolisation, in which case a surgical operation may be offered.
Unfortunately, there is a possibility that the varicocele may come back again. This may also happen after any surgical treatment. If this happens, then the procedure may be repeated, or you may be advised to have an operation.
Who will you see during your procedure?
A specially trained team led by an interventional radiologist, located within the radiology department. This is similar to an operating theatre into which specialised imaging equipment has been installed.
What will happen afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site.
You will generally stay in bed for a couple of hours and then you will be able to go home. Take it easy for the rest of the day but you can resume normal activities the next day.
This information was prepared utilising resources from the British Society of Interventional Radiology.