Overview

This information is about X-ray guided treatment for a varicocele.

A varicocele is a group of enlarged blood vessels (veins) in the pouch (scrotum) around the testicle.

You are having a procedure called varicocele embolisation. This is a specialised, non-surgical method to treat varicoceles that cause:

• discomfort
• swelling
• problems with fertility (the ability to conceive children)

The aim of this information is to help answer some of your questions about having a varicocele embolisation. It explains:

• the benefits of the procedure 
• the risks of the procedure 
• what you can expect when you come to hospital
• what happens after the procedure 

If you have any more questions, please speak to a doctor or nurse caring for you.

About a varicocele

The group of enlarged veins in the scrotum called a varicocele can be on one side or sometimes on both sides.

Varicoceles are fairly common. They affect about 15 in every 100 people.

What causes a varicocele

Usually, blood flows into the testicles through a blood vessel called an artery and out through the veins. The direction of blood flow in the testicular veins should always be back towards the heart.

One-way valves (flaps of tissue that open and close) in the testicular veins stop the blood flowing back to the testicles. Sometimes, these valves are missing or do not work for unclear reasons. This causes blood to collect (pool) in the veins around the testicle and form a varicocele.

Symptoms of a varicocele

You are most likely to be aware of a varicocele when standing. This is because the affected veins can fill with blood as a result of gravity.

Often, varicoceles cause no symptoms and are harmless. Sometimes, they can cause an ache or discomfort in the scrotum.

There is debate about if varicoceles are linked to infertility (being unable to conceive children).

About a varicocele embolisation procedure

A varicocele embolisation is a non-surgical, permanent treatment for varicoceles that cause health issues.

The procedure uses special metal coils (loops), a foam or both to block the affected testicular veins. We do not make any changes to the other veins in the testicles.

A varicocele embolisation is a day case procedure. This means that you only need to spend a few hours in hospital. It is rare to stay in hospital overnight, unless you live far away.

If you have 2 varicoceles or fertility issues, we will treat both sides at the same time. Otherwise, we will only treat the affected side.

Varicocele embolisation is done through a small cut in the neck or the groin. Using X-ray guidance, we carefully position a special wire and tube inside the testicular veins. This allows us to treat the affected veins.

We do the procedure at a special operating theatre in the interventional radiology (IR) department. Interventional radiology is when we use medical imaging guidance to do minimally invasive procedures.

What interventional radiologists do

Interventional radiologists (IR doctors) do minimally invasive, image-guided procedures on different parts of the body. They use imaging machines, such as X-ray and fluoroscopic (continuous X-ray) guidance, to show them exactly where to go inside the body. This avoids the need for large surgical cuts (incisions).

Interventional radiology (IR) procedures are very safe. This is because the IR doctors can clearly see important structures of the body in real time.

IR doctors work in a team with specialist nurses and radiographers (health professionals who specialise in medical imaging). The whole team look after you during your procedure and recovery.

Benefits of the procedure

Varicocele embolisation has various benefits.

• It is less invasive than surgery and does not need a cut in the scrotum. There is a lower rate of complications compared with surgery.
• Varicocele embolisation works as well as surgery. Both treatment options can give similar improvements in pain and semen (liquid containing sperm) analysis.
• If needed, we can treat both sides at the same time through 1 small cut. Surgery involves 2 separate cuts.
• You have a varicocele embolisation under a local anaesthetic. This means that you are awake for the procedure but do not feel pain. Most surgery is done under a general anaesthetic, which is a medicine to make you sleep during the procedure. A general anaesthetic has more risks and possible side effects.
• A varicocele embolisation is usually an outpatient day case procedure. This means that you do not have to stay in hospital overnight.
• The recovery time is usually shorter than for surgery.

Risks of the procedure

Varicocele embolisation is a very controlled and safe procedure, but you need to be aware of some possible side effects:

• There may be mild bruising at the place where we put in a thin tube (catheter). This usually heals within a few days.
• You may get a dull ache in the groin or lower back. This ache should not last more than a few days. It is usually well controlled with pain medicine that you can buy in a pharmacy or shop, such as paracetamol. Always follow the instructions on the packet about how much pain medicine to take.
• There is a small risk of damage to the testicle on the treated side if too many veins are blocked. The IR doctor takes care to avoid this. They might press, or ask you to press, on your groin during the procedure to stop the coils or foam going into your scrotum.
• Sometimes the coils or foam might spill into a different vein, which might then become blocked. The IR doctor usually recognises this immediately and removes the coil or foam from inside the vein. In rare cases, this is not possible and you might need more treatments.

Radiation risks

During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. This may cause cancer many years or decades after you are exposed to it.

You might have some skin redness after the procedure that feels like sunburn. We do not expect this to be permanent. The redness might be harder to notice on brown and black skin. 

Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The amount (dose) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.

The IR doctor and radiographer make sure that:

• your radiation dose is kept as low as possible
• the benefits of having X-rays during your procedure are greater than the radiation risks

Other treatment options

A varicocele embolisation is an elective procedure. This means that you can choose if you have it.

Surgery is also a recognised treatment for varicoceles. Your doctor has recommended varicocele embolisation as the best option for you. However, if you would like more information on surgery, please speak to your doctor.