Varicocele the enlargement of veins within the scrotum affects up to 15% of men and is a leading cause of male infertility. Traditionally treated through open surgery or laparoscopy, varicocele can now be effectively treated using Interventional Radiology's percutaneous embolisation technique no scalpel, no stitches, and patients return home the same day.
What is a Varicocele?
A varicocele is an abnormal enlargement of the pampiniform venous plexus the network of veins that drain blood from the testicle. The condition is analogous to varicose veins of the leg, but occurring in the scrotum. Varicoceles are found in approximately 15% of the general male population and in up to 40% of men presenting with infertility. The condition most commonly affects the left side (because the left testicular vein drains at a 90-degree angle into the renal vein, creating higher venous pressure), though bilateral varicoceles do occur.
- Affects 15% of all men
- Present in 40% of men with infertility
- Usually left-sided
- Can cause testicular pain, discomfort, or atrophy
- Major treatable cause of male factor infertility
How Does Varicocele Affect Fertility?
The exact mechanism by which varicoceles impair fertility is not fully understood, but it is thought to involve increased testicular temperature (due to pooling of warm venous blood), increased oxidative stress, hormonal changes, and possibly reflux of adrenal and renal metabolites into the testicular circulation. The result is impaired sperm production, reduced sperm motility, and abnormal sperm morphology. Treatment of varicocele has been shown to improve semen parameters in the majority of men, and in many cases leads to natural conception or improved outcomes with assisted reproduction.
Varicocele Embolisation How It Works
Varicocele embolisation is an outpatient Interventional Radiology procedure. Using local anaesthesia, a small catheter (thin tube) is inserted into the femoral or jugular vein. Under X-ray fluoroscopy guidance, the catheter is advanced into the testicular vein. Contrast dye is injected to visualise the abnormal refluxing veins (venogram). Metal coils or sclerosant agents are then deployed to occlude (block) the refluxing veins — eliminating the varicocele without any incision. The entire procedure typically takes 30–45 minutes.
- Performed under local anaesthesia no general anaesthesia
- No surgical incision only a needle puncture
- Day procedure go home same day
- No stitches, no surgical scar
- Return to work within 1–2 days
- Success rates comparable to surgical repair
Varicocele Embolisation vs. Surgery
Traditional surgical options include open varicocelectomy (Ivanissevich or Palomo approach) and laparoscopic varicocelectomy. Microsurgical varicocelectomy (subinguinal) is considered the gold standard surgical approach. Embolisation offers significant advantages: it is less invasive, does not require general anaesthesia, has shorter recovery time, can treat bilateral varicoceles through a single access point, and carries lower risk of hydrocele formation (a common surgical complication). Success rates and fertility outcomes are similar between embolisation and microsurgical repair.
Recovery and Results
After embolisation, patients can typically return home within a few hours and resume desk work within 1–2 days. Strenuous activity should be avoided for 5–7 days. Mild groin or lower abdominal discomfort for 24–48 hours is common and managed with simple analgesics. Improvement in semen parameters is typically assessed at 3-month intervals, as spermatogenesis takes approximately 72–90 days. Studies show improvement in semen parameters in 60–80% of treated men, with natural pregnancy rates of 30–40% following treatment.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Please consult Dr. Gurucharan S Shetty or a qualified medical professional for diagnosis and personalised treatment recommendations.
Consult directly with Dr. Gurucharan S Shetty at Sparsh Hospitals, Bengaluru.