Varicocele (Testicular Varicose Veins in Men) and Varicocele Embolization with Interventional Radiology

Introduction

Varicocele is the abnormal enlargement and varicosity of the veins surrounding the testicle. It is considered one of the leading causes of male infertility and can lead to pain, swelling, and sexual dysfunction in the testicles. One of the methods used in the treatment of varicocele is varicocele embolization, which is a minimally invasive approach.  

What is Varicocele?

Varicocele is a condition that occurs as a result of the enlargement of the veins that supply the testicles. Normally, veins have valves that ensure blood flows towards the heart. When these valves are damaged or do not work properly, blood flows backward (reflux) and the vessels around the testicle enlarge. This enlargement is called varicocele and is usually more common in the left testicle. Varicocele is seen in 15-20% of men and in 30-40% of men experiencing infertility problems.

Importance of Varicocele

Varicocele can lead to two main problems:

• Pain: Discomfort and pain in the testicles.
• Infertility: Impairment in sperm production due to increased testicular temperature and other mechanisms.

Varicocele can impair the function of the testicles, leading to infertility and a progressive deterioration in sperm production. Furthermore, if left untreated, it can lead to complications such as testicular shrinkage and other sexual problems.

Diagnosis of Varicocele

Varicocele is usually diagnosed using the following methods:

1. • Physical Examination: The doctor may assess symptoms such as the size of the testicles, swelling, and pain.
   • Color Doppler Ultrasonography (CDUS): This imaging method evaluates retrograde blood flow in detail and helps determine the degree of varicocele.
   • Sperm Test: This is an important parameter in deciding whether treatment is necessary.

   Subclinical Varicocele

   Subclinical varicocele is a varicocele that cannot be detected on physical examination but is diagnosed by imaging methods. Subclinical varicocele can be seen in 35-62% of men, and whether treatment is necessary should be evaluated by a doctor.

   Varicocele Treatment Methods

   Surgical Treatment

   One of the traditional methods in the treatment of varicocele is surgical intervention. It involves ligating or removing the veins that supply the testicles through open surgery. However, surgical treatment may have some risks, such as complications like hydrocele (fluid accumulation around the testicles), infection, and vascular damage.

   Varicocele Embolization

   Varicocele embolization is a minimally invasive method that can be applied as an alternative to surgery. The procedure is performed using an angiography device and is a highly effective option in the treatment of varicocele. Here are the details of varicocele embolization:

   Procedure Steps:

   • Preparation and Anesthesia: The procedure is usually performed under local anesthesia. A thin sheath is placed into a vein in the armpit or groin area.
   • Catheter Placement: The catheter is guided into the testicular vein where the varicocele is located. At this stage, a special dye is used to visualize the veins on the angiography device.
   • Embolization: Special materials (coils, glue, onyx, foam, etc.) are injected into the testicular vein to provide occlusion. These materials close off the varicocele veins, stopping the enlargement.

   Advantages:

   • Minimally Invasive: The procedure only requires numbing the needle insertion site; there is no scalpel incision or large scar.
   • Fast Recovery: The patient is discharged a few hours after the procedure and can immediately return to normal life.
   • Risks: Unlike surgery, there is no risk of pain, infection, hydrocele, and testicular damage.
   • Recurrence Probability: The probability of varicocele recurrence after embolization is lower than with surgical treatment.
   • Bilateral Treatment: If bilateral varicocele is present, both sides can be treated in the same session.

   Recovery Process and Results:

   Significant improvement after varicocele embolization usually begins from the 3rd month and becomes clearer after the 6th month. Studies show a significant increase in sperm count and quality. This treatment option can be an effective alternative, especially in patients who have previously undergone varicocele surgery and have a recurrence.

   Conclusion

   Varicocele is a serious condition that can lead to infertility in men and can cause various complications if left untreated. Both surgical and minimally invasive methods are effective options in the treatment of varicocele. Varicocele embolization offers many advantages over surgery, allowing patients to recover faster and experience fewer risks. Each individual's treatment needs may be different, so it is important to have a detailed evaluation with a urology specialist.

   This information has been verified with medical information confirmed by specialist physician İbadat Hasanov and aims to inform individuals. In any case, the treatment plan is determined specifically for you, and this decision is meticulously evaluated by your doctors.