1. What is a varicocele?
A Varicocele is a network of tangled blood vessels (varicose veins)
in the scrotum. It is a leading cause of male infertility and may
also cause pain and atrophy (shrinkage) of the testicles.
2. What are the advantages of varicocele embolization
versus varicocele surgery?
Unlike varicocele surgery, embolization requires no incision, stitches,
or general anesthesia. Further, embolization patients almost never
require overnight admission to the hospital. In addition, several
studies have shown that embolization is just as effective as surgery.
Studies have also shown that embolization patients return to full
activities in a day or two, but varicocele surgery patients may
need to avoid strenuous activity for several days or even weeks.
Some complications of varicocele surgery, such as hydrocele (fluid
around that testicle) and infection are virtually unheard of after
embolization.
3. Should all varicoceles be repaired?
Not necessarily. If you have symptoms, such as pain, you may choose
to have a varicocele repair procedure sooner. But an asymptomatic
varicocele is a common condition that does not necessarily cause
pain or infertility. A varicocele only needs to be fixed when it
causes pain, shrinkage of a testicle, or when it is associated with
male infertility.
4. Will varicocele embolization improve my
semen analysis?
Many studies have shown that varicocele repair can improve semen
analysis significantly, but there is no guarantee that any individual
patient will experience a significant improvement. Pregnancy rates
in infertile couples improve after varicocele repair by about 30-50%.
5. Will the varicocele repair procedure reduce my
pain?
Successful varicocele repair reduces the swelling and discomfort
of symptomatic varicoceles. There are other causes of scrotal pain
that may need to be ruled out before varicocele treatment.
6. What are the risks or complications of the procedure?
Minor complications such as bruising at the catheter site, nausea
or low-grade backache may occur, but are uncommon. Infection, hydrocele
or loss of a testicle have not been reported after coil embolization.
7. Is the procedure painful?
The procedure is performed with local anesthesia and "twilight"
sedation. It is not a painful procedure. In one study, patients
who underwent both varicocele surgery and embolization for varicocele
repair, overwhelmingly favored embolization.
8. How long will I be in the hospital?
Typically, patients are observed for a few hours and go home the
same day.
9. What are my restrictions after the procedure?
Patients are instructed to rest quietly at home on the day of the
procedure. They may resume normal activity the next day. Varicocele
surgery often has a longer recovery time.
10. How much work will I miss?
While every patient is different, recovery from varicocele embolization
typically takes less than 24 hours and many patients return to work
the next day.
11. Will the procedure affect sexual function?
No.
12. Is there a chance that the varicocele
will recur after varicocele repair?
There is a 5-11% chance that a varicocele could recur after embolization.
If so, surgery may be needed. Keep in mind that a varicocele may
also recur after surgery.
13. I had varicocele surgery but my varicocele
has come back. Can varicocele embolization help me?
Yes. Embolization is a highly effective way to repair varicocele
after varicocele surgery.
14. What does varicocele embolization cost?
The cost is generally comparable to varicocele surgery. However,
the cost varies depending on geographic area and local insurance
company policies. You should contact a local interventional radiologist
to discuss the cost in detail.
15. Will my insurance pay for varicocele embolization?
Generally, insurance companies will pay for the varicocele embolization
if they pay for varicocele surgery. Understand, however, that some
insurance companies limit the coverage provided for infertility
treatment. Check with you insurance company about this policy.
16. If x-rays are used to guide varicocele
embolization, is there a danger of radiation exposure?
Although the radiologist guides the catheter with an x-ray machine
during embolization, the amount of radiation exposure to the testicle
is very low - about equal to the amount received during a chest
x-ray.
17. During varicocele surgery, there is an
incision made in or near the scrotum. Is there one made during varicocele
embolization?
During varicocele embolization, no incision is made in or near
the testicles. Rather, a tiny nick is made in the leg to insert
a catheter (a small tube). Next, the catheter is guided up to the
abdomen and into the varicocele vein. After the procedure, the catheter
is removed and no stitches are needed.
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