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The two mainstays of treatment for varicoceles include:
Surgical therapy for varicoceles
Surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles with studies suggesting over 90% of varicoceles are treated in such a manner. Surgical therapy involves ligating or tieing off all abnormal veins that drain the testicle to help restore normal blood flow. All venous channels which drain the testis can be visualized and treated.
Our microsurgically-trained experts perform this surgery routinely. An operating microscope is utilized to help aid in the precise identification of veins so as to maximize efficacy and minimize complications. The outpatient, one-hour surgery is generally performed on Fridays with most men/boys returning to school or work on Monday. Light activity is requested for a week.
Interventional therapy for varicoceles
Interventional therapy by catheter directed embolization involves puncturing a large vein in the arm, leg, or neck, and then clogging off the offending scrotal veins.
Catheter directed embolization is a non-surgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure.
For the procedure, an interventional radiologist makes a tiny nick in the skin at the arm, neck, or groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so s/he can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, sclerosant chemicals, or glue, 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. Most men require one to two days for complete recovery after embolization.
Efficacy of Varicocele Treatment
Studies support that varicocele treatment can improve fertility or scrotal pain in 60-70% of men.