Embolization Versus Surgery For Treatment Of Varicocele

What are Variceceles?

Varicoceles are engorged veins in the scrotum that can cause pain or infertility in men and can even cause shrinkage of the affected testicle. This is usually caused by insufficient drainage of one of the veins which drain the testicle which goes up to the mid abdomen. Treatments generally involves closing this malfunctioning vein. Surgery is a common way to close the vein, but it requires an incision, can be painful and can result in adverse complications.

Varicocele embolization is a newer non-surgical option where a thin tube is inserted into the vein and a special material is used to block off the blood flow. This doesn't require a cut and is usually easier to recover from and has less complications as reported in clinical studies.. 

Treatment Options for Symptomatic Varicocele 

The surgical options include the following:

• Open surgery: To perform open surgery, the doctor may use either general or local anesthesia. A small incision will be made at the scrotum, groin or lower abdomen. The doctor further uses a microscope and ultrasound tests to view the area to be treated.
• Micro Varicocelectomy: It is a complex procedure that removes the swollen veins in the scrotum. It makes use of a high-power microscope to identify the exact veins. Though the procedure is complex,but may have less complications compared with open surgery. It ican be performed under local anesthesia.
• Laparoscopic surgery: It is performed by making a small incision in the abdomen and by using cameras to view the inside of the body. Gas is filled in the abdomen so that the doctor can easily view and perform the procedure. This type of surgery has a risk of developing complications and it requires general anesthesia. It can be uncomfortable for a few days as the gas and distension of the abdomen causes irritation.

Varicocele Embolization – Minimally Invasive Non-surgical Treatment: 

It is a minimally invasive procedure and it can be performed without general anesthesia. During the procedure, a thin tube is inserted into a vein, from a needle puncture access, a little larger than an IV line, usually in the groin. Using imaging such as an X-ray on the monitor, the doctor directs the catheter towards the site to be treated. The radiologist then releases some surgical material in the damaged vein (platinum coils) and a medical solution to block the damaged vein. Due to this, the blood flow to that damaged vein gets blocked and the blood flow gets redirected to other healthy veins.

Comparing Varicocele Surgery and Embolization

There are differences between varicocele surgery and embolization in terms of recovery, hospital stay, success rate, etc.

• Anesthesia: Both open surgery and microsurgery requires either general or local anesthesia. Whereas laparoscopic surgery requires general anesthesia. The embolization procedure can be performed with sedation with less risks involved with general anesthesia.
• Recovery:  The recovery from surgery takes around 2 to 3 weeks and the doctor might prescribe medications to relieve your pain and discomfort after the procedure. You can resume exercises two weeks after surgery. You can resume your sexual activities after 4 weeks of surgery.
• On the other hand, the recovery from embolization is very short and it is 2 or 3 days with possible mild discomfort. Most men feel fine immediately after the procedure. You can start your physical activity after a week of embolization. You can resume sexual activity after 1 or 2 weeks of embolization.
• Success rate: With varicocele surgery, one out of 10 men may experience the reoccurrence of varicocele. Microsurgery is the most effective one of all the surgical options. Embolization has a 90% success rate and it offers long-term results equivocal with surgery with less risk.
• Scarring: Surgery can cause some scarring as incisions are made during surgery. Embolization does not cause any scarring as no incisions are made.
• Possible risks: Surgery can pose risks such as infection, hydrocele (fluid buildupp around the testicle) reoccurrence of varicocele, and artery damage. But embolization has fewer to exceedingly low risks and less pain.

What are the Benefits of Undergoing Treatment for Varicocele?

Men that wish to have treatment for symptomatic varicocele have choices in choosing treatment. Whether you choose surgery or embolization for varicocele treatment, it can relieve your pain and discomfort. The treatment also brings your testicles to their normal size and improves the quality and quantity of sperm.

Evolutions in technology and medical techniques have brought alternatives to surgery that offer comparable results. If you are diagnosed with varicocele, embolization can an advantageous choice due to its efficacious track record with less risk compared to surgery. But you should discuss with your doctor if you can undergo embolization.