What is Varicocele?
Varicocele occurs when the veins taking blood away from the testis become bigger
than normal and blood flows in the wrong direction. Similar to varicose veins in the
legs, but involving the internal testicular veins.
Symptoms of Varicocele
Symptoms range from scrotal swelling or scrotal pain to reduced fertility and testicular atrophy. Scrotal discomfort associated with a varicocele may be worse during standing, exercising, or cycling.
It is sometimes diagnosed when a couple undergoes investigation for infertility and there is low sperm count in the male partner.
You may or may not be able see these enlarged veins from the outside on examination. Often varicocele present with symptoms rather than visible veins in the scrotum.
How is varicocele diagnosed?
It requires a physical examination. Any scrotal or testicular swelling should prompt a visit to the doctor’s office. You should have it examined by a GP or specialist.
An ultrasound is the best test to diagnose a varicocele. Doppler ultrasound is used to grade the degree of reflux in the testicular vein. You may also be asked to do a Valsalva manoeuvre to bring out the veins and abnormal direction of blood flow on ultrasound. Your specialist will determine what tests are required if you need further investigations.
What are the treatment options for a varicocele?
There are a number of ways to treat varicoceles. Open groin surgery and laparoscopic surgery to tie off the vein. Interventional radiology uses a minimally invasive technique with Xray guided entry into the testicular vein to perform an embolisation ie. closure of the abnormal vein. It is done via a tiny incision in the groin or the neck.
Benefits of varicocele embolisation
- Embolisation of varicocele has a high success rate in closing the culprit refluxing testicular veins. It can reverse subfertility and improve symptoms. Though it is important to remember that infertility is often related to many different factors. Pregnancy rate is therefore lower than technical success rate. The same goes for surgical ligation of the vein.
- No general anaesthesia is required. The minimally invasive procedure if done under local anaesthetic or light sedation.
- The entire procedure can performed through a tiny incision. There are no cuts or scars at the groin.
- The procedure is less painful than surgery.
- Time to return to normal activity is much quicker than surgery, typically 1-2 days.
Risks of a varicocele embolisation procedure
With any medical procedure, there are minor risks and complications. The most common is a small bruise or haematoma around the site where a needle has been inserted into the vein, which will resolve in one to two weeks. Some patients may feel mild pain or discomfort in the scrotum or abdomen region after the procedure, which is usually temporary.
A very rare complication is the coil used to close the vein migrates to the other parts of the body. There is a possibility of unsuccessful embolisation or return of the varicocele after treatment. These risks and side effects will be discussed with you in detail prior to the procedure.
If you have any of the above symptoms, contact us today to undergo an ultrasound scan and consultation.
Frequently Asked Questions
Why do I need Pelvic Vein Embolisation (PVE)?
Embolisation is intended to close off the pathologic veins so that blood can no longer flow backwards. This will help reduce pain and other symptoms by removing pressure of the bulging veins on surrounding pelvic organs and nerves.
Who will be performing Pelvic Embolisation and where will it happen?
The procedure is usually completed in an angiography suite by a qualified doctor such as a vascular surgeon or interventional radiologist.
How long does the PVE procedure take and what happens after treatment?
The procedure will take in general between 60-90 minutes but may take longer depending on how many veins require treating. After the treatment you have to stay in the recovery area whilst nurses complete routine observations on your blood pressure and pulse. When discharged home, you should arrange for someone to collect you.
Will I need to stay in hospital overnight?
Pelvic Vein Embolisation is normally a day procedure and you should not need to stay in hospital overnight.
How long does it take for my symptoms to resolve?
Often a significant improvement in pain is apparent within the first few days post procedure.
Are there any side effects?
It is usual for patients to experience some pelvic cramps following the embolisation for a few days, but this will gradually improve after the first 24 hours and can usually be controlled with pain relief medication. Most patients will be fully recovered after 1 week.
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