There are no medications available that can treat a varicocele. Treatment options include embolization, a minimally invasive outpatient procedure done by an Interventional Radiologist, and more invasive surgery, performed by a Urologist. Both treatment options are very successful and have low risks. Studies also show that both options have about the same success rates with improvement of testicular growth and sperm production.
Surgery involves general anesthesia and an incision in the groin area, with a longer recovery time that usually last days or even more than a week. Depending on type of surgery done, there is a small risk of damaging the artery that supplies blood to the testicle, and sometimes there are multiple abnormally dilated veins that can be missed at the time of surgery. Additionally, some patients patients develop a hydrocele after surgery, which is a harmless but bothersome recurrent accumulation of fluid in the scrotum caused by surgical damage to lymph vessels in the area. For all of these reasons, embolization is an excellent treatment choice for your or your family member's varicocele, even if surgery has been tried already and didn't work.
Ultrasound of a varicocele after unsuccessful surgery.
Embolization is a procedure with the same success rate as surgery, but it is far less invasive, has fewer risks, and a shorter recovery time. The procedure is done by placing a tiny catheter into the "broken" gonadal vein and its branches, and shutting down the blood flow by injecting tiny metallic coils that clog the main vein up, along with a medication that causes the smaller vein branches to shrivel up. Everything is done through a tiny quarter-inch skin hole, and general anesthesia is not needed because the procedure is not painful. The procedure typically lasts less than an hour, and patients go home the same day wearing a small bandage, with only 1-2 days of recovery before returning to normal life.
Patients usually notice their scrotal pain goes away within a week. The bulging veins also get better quickly, but this can take longer for larger varicoceles. Like with surgical treatment, improvements in sperm production and testicular growth can take several months to be seen. The only potential disadvantage of the embolization procedure compared to surgery is the radiation exposure that younger patients receive during the X-ray-guided parts of the procedure. However, the utmost care is taken to minimize the amount of X-rays used, and typically patients don't get much more radiation than they would get from a regular abdominal X-ray, which is very little.