What is a Varicocele?

A varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems. Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele. As a treatment, urologists often suggest open surgery (surgical ligation), but at Verona Veins, Dr. Elsie Koh offers varicocele embolization, which is as effective as surgery with less risk, less pain and less recovery time. For the procedure, our physicians make a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter is passed into the femoral vein, directly to the testicular vein. By using coils, balloons, or particles, the blood flow in the vein is blocked, reducing pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways.

Who Has Varicoceles? (Prevalence)

  • Approximately 15-17% of men have varicoceles
  • 30-40% of infertile men are affected by varicoceles
  • Highest occurrence is in men aged 15 – 35



What are the Symptoms of Varicoceles?

  • Pain – Aching pain when an individual has been standing or sitting for long periods of time and pressure builds up on the affected veins. Typically, painful varicoceles are prominent in size.
  • Fertility Problems – There is an association between varicoceles and infertility. The incidence of varicocele increases to 30 percent in infertile couples. Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. Some experts believe that blocked and enlarged veins around the testes, called varicocele, cause infertility by raising the temperature in the scrotum and decreasing sperm production.
  • Testicular Atrophy – Shrinking of the testicles is another sign of varicocele. Often, once the testicle is repaired, it will return to normal size.


How is a Varicocele Diagnosed?

Your diagnosis would be fairly simple through either physical or diagnostic examination.

  • Typical on left side of scrotum
  • Visual physical exam – scrotum looks like a “bag of worms”
  • Testicle can shrink in size (atrophy)


When varicoceles are not clearly present, the abnormal blood flow can often be detected with a noninvasive imaging exam, called color flow ultrasound; or through a venogram, an x-ray in which a special dye is injected into the veins to “highlight” blood vessel abnormalities.


Varicocele Treatment Options

Varicocele Surgery, performed by a urologist, is a common treatment for symptomatic varicocele. However, there is a non-surgical alternative: Varicocele embolization, a minimally-invasive treatment performed by an interventional radiologist, is as effective as surgery with less risk, less pain, and less recovery time. If you are considering surgical treatment, we recommend you also get a second opinion from our physicians to ensure you know all of your treatment options.

Varicocele Embolization (Varicocele Treatment without Surgery)

Varicocele embolization is a non-surgical, outpatient varicocele treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, you will be relaxed and pain-free during the approximately two-hour procedure.

For the procedure, an interventional radiologist will make a tiny nick in your skin at the groin through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so he/she can map out exactly where the problem is and where to embolize or block the vein.

By using coils, balloons, or particles, the interventional radiologist blocks the blood flow in the vein, which reduces pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways. Essentially, the incompetent vein is “shut off” internally by preventing blood flow, accomplishing what the urologist does, but without surgery.


Effectiveness of Varicocele Embolization

Varicocele embolization is equally effective in improving male infertility and costs about the same as varicocele surgery. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy.


Varicocele Embolization Recovery Time

  • Average of one to two days for complete recovery for embolization, compared to two to three weeks for surgery
  • Twenty-four percent of surgical ligation patients required overnight hospital stay, compared to none for embolization

Benefits of Varicocele Embolization

  • No surgical incision in the scrotal area
  • Effective as surgery, as measured by improvement in semen analysis and pregnancy rates
  • Less recovery time – patients are able to return to normal daily activities immediately and without hospital admittance
  • A patient with varicoceles on both sides can have them fixed simultaneously through one vein puncture site, compared to surgery, which requires two separate open incisions
  • No general anesthesia
  • No sutures
  • No infections
  • Cost-effective

Want to see a Physician about Varicocele Embolization in the North Jersey area?

Request an appointment today and meet with one of our board certified physicians in our convenient Woodland Park, NJ location.