A varicocele is an abnormality of the veins that take blood away from the testicles. The veins become bigger and more obvious, rather like varicose veins in the leg. Embolisation is a way of blocking these veins, thus making them less obvious and causing the varicocele to disappear without an operation.
Varicocele can cause various problems, including infertility. In the past, an open operation would have been necessary to get rid of the varicocele. Embolisation is less invasive, with fewer risks and faster recovery. Your consultant and the radiologist performing the embolisation have discussed your case and feel that this treatment is most appropriate for you. You will have the opportunity to talk with them and are not obliged to give your consent to the procedure if you do not want it.
It is important that you understand the risks and benefits of any procedure before giving your consent for treatment. If you have any questions or concerns, or have not received enough information about the procedure, please discuss this with us before you sign the consent form.
A specially trained consultant called an interventional radiologist.
In the x-ray department, in a specially adapted ‘screening’ room.
You will lie on the x-ray table, usually flat on your back. You may have a monitoring device attached to your chest and finger, and your blood pressure will be recorded. The skin and deeper tissues over the vein will be made numb with local anaesthetic, and then a needle will be inserted into a suitable vein, which could be in your neck, groin or arm.
Once the radiologist is satisfied that this is positioned correctly, a guide wire is placed through the needle and into the vein. The needle is then withdrawn allowing a fine plastic tube (catheter) to be placed over the wire and into the vein. X-ray equipment is used to ensure the catheter is correctly positioned in the varicocele before withdrawing the wire.
The radiologist can then block the abnormal veins by passing small metal coils down the catheter. These coils are like small springs and cause the blood around them to clot, blocking the vein. Small amounts of dye will be injected down the catheter to check that the abnormal veins are being blocked; this may cause a warm sensation. Once they are blocked completely the catheter will be removed. The radiologist will then press firmly on the small puncture wound for several minutes to prevent any bleeding.
When the local anaesthetic is injected it will sting at first but this soon wears off and the skin and deeper tissues should then feel numb. After this the procedure should not be painful. A nurse will stand next to you, looking after you throughout the procedure. If the procedure does become painful they will arrange for you to have more painkillers.
You will be awake during the procedure, and able to tell the radiologist if you feel any pain or discomfort.
Every patient's situation is different but you can expect to be in the x-ray department for up to two hours.
You will be made comfortable in the recovery area where nurses will monitor you and check the skin puncture to make sure there is no bleeding from it.
You will be required to remain here for about an hour, until you have recovered. You will usually be allowed home on the same day.
You may eat and drink normally but you should take things easy for the rest of the day. Please keep the puncture site dry for 24 hours.
You may have some pain and discomfort for 2 or 3 weeks as the varicocele blocks off. Please take your usual painkillers.
You should be able to resume your normal activities within 24 hours. You should avoid:
- Strenuous exercise and heavy lifting for two weeks
- Contact sports (such as rugby) for two weeks
Varicocele embolisation is a very safe procedure designed to avoid the necessity of a larger operation. However, there are some minor risks and complications that may, infrequently, arise:
- Dull aching in the groin or lower back: this usually lasts for a few days and you can take over-the-counter painkillers.
- There may be a small bruise (haematoma) around the site where the needle has been inserted; this is quite normal.
- The coil could move (migrate)
- There is a chance that the varicocele may come back. However this may be months or even years later. If this happens the procedure may need to be repeated or you may be advised to have an operation.
- Occasionally patients develop a rash due to an allergy to the dye: this almost always responds rapidly to medical treatment.
Despite these possible complications, the procedure is normally very safe and is carried out with no significant side effects.
- The coils left in your body are normally compatible with MRI scanners so should be safe if you ever need to have an MRI scan. However, if having an MRI in the future please advise staff that you have had this procedure.
- The coils will not set off metal detector alarms, e.g. at airports.