WHAT IS A VARICOCELE?

A varicocele is an abnormal dilation of the veins in the scrotum.  These veins are normally very small, and they transport venous blood from the testicle and send it back up through the gonadal vein towards the heart.  There are one-way valves in the gonadal vein that normally prevent blood from flowing back down in the wrong direction towards the scrotum.  But if these valves stop working, gravity causes blood to flow back down into the veins in the scrotum, and they become dilated, painful, and ugly.

This problem is known as venous reflux.  It can be caused by activities that involve a lot of standing, pushing on the abdominal muscles, or heavy lifting. Over time, the dilation gets worse. This  process is similar to the development of varicose veins in the legs.  The diagnosis of a varicocele is usually straightforward - often an ultrasound and physical exam are all that is necessary.

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Varicoceles are common, and occur in up to 1 out of 5 males. They are not harmful or medically dangerous, but they can be painful, ugly, and make normal activities too uncomfortable to bear.  Also, the increased blood flowing back into the scrotum can cause poor testicular growth in children and decreased sperm production in adults. Thus any varicocele that causes problems is worth treating.

YOUR TREATMENT OPTIONS...

There are no medications available that can treat a varicocele. Treatment options include embolization, a minimally invasive outpatient procedure performed 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 results with improvement of testicular growth and sperm production.

SURGERY...

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, 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.  Also, some patients may develop a hydrocele after surgery, which is a harmless but bothersome recurrent accumulation of fluid in the scrotum caused by 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 failed surgery.

VARICOCELE EMBOLIZATION

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.  Some people get concerned about 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 more radiation than they would get from a regular abdominal X-ray, which is very little.

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