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Varicocele – Most common cause of male infertility

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What is a varicocele?

A varicocele is an abnormal enlargement of veins in the scrotum. It is a relatively common condition effecting males in the second and third decade with it’s incidence being higher in infertile couples. Varicocele is often described as a feeling of bag of worms. They are more common on the left side but can occur on both sides.

What causes varicocele?

Blood flows to the testicle through an artery and flows out via tiny network of veins, which drain into a long testicular vein that goes up into the abdomen. The veins have a series of valves, which allow blood to flow only in one direction. Failure of these valves to function causes stretching and enlargement of the veins around the testicle, which is called varicocele

What are the symptoms of varicocele?

Pain- Patients with varicocele experience discomfort or aching sensation usually by the end of the day. This is due to the increased pressure in the veins secondary  to blood pooling.

Infertility- There is an association between infertility and varicocoeles. Most men with varicocoeles are not infertile. However, if you have a varicocoele, then there an increased chance of infertility.  Among infertile couples, the incidence of a varicocoele is about 30%. It is thought that the increased blood flow around the scrotum is responsible for raising the temperature in the testicles and results in defective sperm formation. Varicocoeles may cause decreased sperm count, decreased motility of sperm, or an increase in the number of deformed sperm.

Testicular atrophy- Another symptom of varicocoeles is the shrinkage of the testicles, also known as atrophy.

How is a varicocele diagnosed?

Varicocele is diagnosed by clinical examination and ultrasound.

What are the treatment options for varicocele?

Varicocele embolization and surgical ligation are the current treatment modalities available.

Varicocele embolization: Varicocele embolization is a minimally invasive, day care procedure performed by interventional radiologists under imaging guidance. In this procedure a small nick is made in the skin at the groin and then a thin catheter is passed into the testicular vein. Then by using coils or sclerosing agents the blood flow in the incompetent testicular vein is blocked. So the vein is blocked internally without the need for a surgery in the scrotum.

Surgery: Surgery involves ligation of the testicular veins after a incision above the scrotum under general anesthesia by a urologist.

What are the benefits of varicocele embolization over surgery?

  • No incision above the scrotal area.
  • Varicocele embolization is as effective as surgery, measured by improvement in semen analysis and pregnancy rates.
  • Bilateral varicoceles can be treated at the same time using the same approach in embolization. Surgery requires two separate incisions.
  • Less post operative recovery time and early return to normal daily activities
  • No general anesthesia
  • No sutures are required
  • No infections

How effective is varicocele embolization?

Varicocele embolization is as effective as surgery for the treatment of varicoceles as measured by improvement in pain, semen analysis and pregnancy rates. Patients who have had both procedures express a preference for embolization. Varicocele embolization has been performed for over 25 years and has an excellent long-term safety record. Its safety and effectiveness has been shown in very large trials.

Will varicocele embolization improve my semen analysis?

Many studies have shown that varicocele repair can improve semen analysis significantly, but there is no guarantee that any individual patient will experience a significant improvement. Pregnancy rates in infertile couples improve after varicocele repair by about 30-50%.

What are the complications of varicocele embolization?

Minor complications like bruising at catheter insertion site, nausea and low back ache may occur. Infection and hydrocele have not been reported after varicocele embolization.

What is the recovery time from the procedure?

Patients are discharged the same day after the procedure and they can resume normal daily activities the very next day. Recovery time post surgical ligation is about 2 to 3 weeks.

Will the procedure affect sexual function?

No. Varicocele embolization doesn’t affect the sexual function.

Will varicocele recur after embolization procedure?

Recurrence rates after varicocele embolization are similar to surgery.

Can embolization be done for recurrent varicocele after previous surgery?

Yes embolization can be performed to treat the recurrent varicocele after surgery effectively without any further scars.

Surgical ligation Varicocele embolization
Done under general anesthesia No general anesthesia required
Sutures required No sutures or scar formation
Recover time is 2 to 3 weeks Can resume activities next day
Overnight stay required Discharged on the same day
Bilateral varicoceles require two separate incisions Bilateral varicoceles can be treated using a small nick on one side