In varicocele ligation surgery, an incision is made in the skin above the scrotum, cutting down to the testicular veins, and tying them off with sutures. It is usually performed under general anesthesia. Although patients leave the hospital the same day, there is a two to three week recovery period.
Varicocele embolization is an outpatient procedure that is performed without general anesthesia using "twilight" sedation. In this procedure, a small tube is inserted into the femoral vein in the groin or a vein in the neck through a small nick in the skin (about the size of the lead in a pencil). The skin is numbed for this procedure and it is not painful. Next, a small catheter, or tube, is painlessly guided into the abdomen and into the varicocele vein under the guidance of x-ray imaging (see Figure). The vein is then intentionally closed off by plugging it with small metals coils and a special medication (the same sclerosant medication injected into leg varicose veins). The procedure takes 30 minutes and the patient goes home a few hours later with only a band aid at the puncture site. They can immediately resume their non exertional activities.
The advantages of varicocele embolization include:
- Performed under local anesthesia with mild sedation (general anesthesia used for varicocele ligation).
- Performed on an outpatient basis in our office endovascular suite, not in a hospital.
- No surgical incision in the groin, only a tiny hole in the skin where a catheter is placed. Leave the office with only a band aid.
- A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions).
- It is as effective as surgery, as measured by improvement in pain, semen analysis and pregnancy rates.
- Lower rate of complications compared to surgery. Infection has not been reported after embolization.