VASCULAR & IR

Varicocele Embolization

Male Infertility Caused by Varicocele

Highly effective, nonsurgical treatment is underutilized. A varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems. Veins contain one-way valves that work to cause all blood to flow from the testicles and scrotum back to the heart. When these valves fail, they cause blood pools and enlarge the veins around the testicle in the scrotum to cause a varicocele. Open surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles. Varicocele embolization, a nonsurgical treatment performed by an interventional radiologist, is a highly effective, widely available technique to treat symptomatic varicoceles that is greatly underutilized in this country.

 

Prevalence

Twenty to forty percent of women ages 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size. Uterine fibroids are the most frequent indication for hysterectomy in pre-menopausal women and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, one-third of these are due to fibroids.

Efficacy

Embolization is an equally effective technique to treat 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.

Treatment

Currently there are two treatment options for men with varicoceles:

  1. Catheter-directed embolization: This is a nonsurgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the procedure, which lasts approximately two hours. For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so he or she can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, balloons or particles, the interventional radiologist blocks the blood flow in the vein, which reduces pressure on the varicocele. By embolizing the vein, blood flow is redirected to other healthy pathways. Essentially, the incompetent vein is shut off internally by preventing flow, accomplishing what the urologist does, but without surgery.

  2. Surgical treatment of varicocele: After the patient receives anesthesia, an incision is made in the skin above the scrotum, cutting down to the testicular veins, and tying them off with sutures. Although patients leave the hospital the same day, there is a two-to-three-week recovery period.

 

Recovery Time

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.

Benefits of Embolization

  • No surgical incision in the scrotal area.

  • Effective as surgery, as measured by improvement in semen analysis and pregnancy rates.

  • Less recovery time: patients are able to return to normal daily activities immediately and without hospital admittance.

  • A patient with varicoceles on both sides can have them fixed simultaneously through one vein puncture site, compared to surgery, which requires two separate open incisions.

  • No general anesthesia.

  • No sutures.