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Male Urology & Fertility IR

Minimally invasive, image-guided vascular interventions for male urological and fertility conditions including varicocele embolisation, Prostate Artery Embolisation for BPH, and male fertility-related procedures without open surgery.

  Varicocele Embolisation
  Prostate Artery Embolisation (PAE)
  Fertility IR
Male Urology IR

Varicocele Embolisation

A varicocele is an abnormal enlargement of the pampiniform plexus of veins within the scrotum, similar to varicose veins of the leg. They occur in approximately 15% of all men and are found in up to 40% of men investigated for infertility. Varicoceles cause elevated scrotal temperature, impair sperm production, reduce testosterone levels, and can cause chronic scrotal discomfort. Varicocele embolisation is a minimally invasive, catheter-based treatment that seals the abnormal veins without any incision into the scrotum or groin.

Using fluoroscopic guidance, the interventional radiologist accesses the internal spermatic vein via a small puncture in the neck or groin, passes a catheter to the varicocele, and deploys embolic coils and/or sclerosant foam to permanently occlude the dilated veins. This eliminates reflux of blood into the pampiniform plexus, allowing the scrotum to cool and sperm function to recover.

Who Needs Varicocele Embolisation?

Varicocele embolisation is indicated for men with a palpable or ultrasound-confirmed varicocele associated with male-factor infertility (abnormal semen analysis), couples undergoing assisted reproduction where varicocele correction may improve outcomes, and men experiencing chronic scrotal pain or heaviness attributable to varicocele. It is also suitable for adolescents with a significant varicocele causing ipsilateral testicular hypotrophy (reduced growth), and men with low testosterone associated with a clinical varicocele.

How is the Procedure Performed?

  • Access: Under local anaesthesia and light sedation, a catheter is introduced via the right internal jugular vein (neck) or the femoral vein (groin) both are tiny punctures, no scrotum or groin incision is needed.
  • Venography: Contrast is injected to map the internal spermatic vein and confirm the location and extent of the varicocele under fluoroscopic guidance.
  • Embolisation: Embolic coils (platinum or stainless steel) and/or sclerosant foam are delivered through the microcatheter to occlude the dilated internal spermatic vein and its collaterals at multiple levels, preventing recanalization.
  • Bilateral Treatment: Both left (most common) and right varicoceles can be treated in the same session without additional access sites.
  • Completion: Once venography confirms no further reflux, catheters are removed. The patient is observed briefly and typically discharged the same day.
Clinical Evidence: Multiple studies and meta-analyses confirm that varicocele treatment improves semen parameters sperm count, motility, and morphology in the majority of men, with pregnancy rates comparable to surgical varicocelectomy. Embolisation avoids the hydrocele risk associated with open surgery.

Varicocele Embolisation vs. Surgical Varicocelectomy

Embolisation (IR)

  • No scrotal or groin incision
  • Local anaesthesia only
  • Day procedure, home same day
  • Return to work in 1–2 days
  • No hydrocele risk
  • Bilateral treatment in one session

Surgical Varicocelectomy

  • Groin or scrotal incision required
  • General or spinal anaesthesia
  • Short hospital stay
  • Return to work in 5–7 days
  • ~5–10% hydrocele formation risk
  • Bilateral requires separate access
Varicocele embolisation procedure
Male Urology IR

Prostate Artery Embolisation (PAE)

Benign Prostatic Hyperplasia (BPH) or an enlarged prostate affects over 50% of men by age 60 and up to 90% by age 85. Symptoms include urinary frequency, urgency, weak stream, incomplete bladder emptying, and nocturia, significantly impacting quality of life. Prostate Artery Embolisation (PAE) is a cutting-edge, minimally invasive radiological procedure that reduces prostate volume by selectively blocking the small arteries supplying the prostate gland, causing it to shrink without open surgery.

Unlike transurethral resection of the prostate (TURP) the traditional surgical gold standard PAE does not require general anaesthesia, involves no cutting inside the urethra, and carries no risk of retrograde ejaculation or erectile dysfunction. It is an outpatient or short-stay procedure with rapid recovery.

Who is a Candidate for PAE?

PAE is indicated for men with moderate to severe lower urinary tract symptoms (LUTS) due to BPH who have failed or are intolerant of medical therapy (alpha-blockers, 5-alpha reductase inhibitors), men who wish to avoid surgical risks such as retrograde ejaculation or urethral stricture, elderly men or those with significant comorbidities where TURP carries elevated anaesthetic risk, and men with very large prostates (over 80 ml) in whom TURP may be technically challenging or incomplete. It is also suitable for men with urinary retention who are catheter-dependent and seek a non-surgical path to catheter removal.

How is PAE Performed?

  • Pre-procedural Planning: A CTA or MRA of the pelvis is performed beforehand to map the prostate arterial anatomy critical as prostatic arteries are small (1–2 mm) and highly variable between individuals.
  • Access & Navigation: Under local anaesthesia and conscious sedation, a catheter is introduced via the femoral or radial artery. Using biplane fluoroscopy and roadmapping, a microcatheter is steered selectively into the prostatic arteries bilaterally.
  • Embolisation: Tiny microspheres (100–300 microns) are injected through the microcatheter to selectively block the prostate's blood supply. Non-target embolisation of adjacent structures (bladder, rectum) is carefully avoided using meticulous technique and cone-beam CT guidance.
  • Bilateral Treatment: Both left and right prostatic arteries are embolised in the same session. Post-embolisation angiography confirms satisfactory devascularisation.
  • Recovery: Most patients are discharged within 24 hours. Prostate volume reduction of 20–40% is typically seen over 3–6 months, with progressive improvement in urinary symptoms.
Clinical Evidence: PAE is supported by high-quality randomised controlled trial data (ROPE study, BLISS trial, EMBOLIZE trial) demonstrating durable symptom improvement (IPSS reduction of 10–15 points), significant prostate volume reduction, and importantly, preservation of sexual function with zero incidence of retrograde ejaculation or de novo erectile dysfunction compared to TURP.
Prostate artery embolisation PAE
Male Fertility IR

Male Fertility-Related Vascular Interventions

Beyond varicocele correction, interventional radiology offers targeted, minimally invasive treatments for several vascular conditions that affect male reproductive health. These include percutaneous embolisation of post-surgical or spontaneous arteriovenous fistulas (AVFs) within the scrotum or pelvis, management of pelvic congestion syndrome-related venous insufficiency in men, and venographic assessment prior to assisted reproductive procedures. These precise catheter-based interventions correct the underlying haemodynamic abnormality with minimal disruption to surrounding structures.

IR also plays a role in the management of post-orchidopexy or post-hernia repair vascular complications, including testicular venous thrombosis, pelvic venous collateralisation, and scrotal hematoma drainage, all performed under imaging guidance to ensure accuracy and patient safety.

Conditions Treated

  • Varicocele (Primary & Recurrent): Embolisation for new diagnoses and for varicoceles that have recurred following previous surgical ligation.
  • Post-surgical Scrotal AVF: Embolisation of inadvertent arteriovenous fistulas formed after inguinal surgery, orchidopexy, or hernia repair causing pain, swelling, or vascular steal.
  • Pelvic Venous Insufficiency in Men: Venographic identification and targeted embolisation of incompetent pelvic veins contributing to pelvic congestion, scrotal heaviness, and perineal pain.
  • Scrotal Collection Drainage: Ultrasound-guided aspiration and drainage of scrotal haematomas, hydroceles, or post-operative seromas causing discomfort or infection.
  • Pre-ART Vascular Assessment: Dedicated scrotal and pelvic venous mapping for couples undergoing IVF/ICSI, identifying subclinical venous reflux amenable to correction prior to sperm retrieval procedures.

Benefits Across All Male Fertility IR Procedures

Key Advantage: All male fertility IR procedures preserve testicular blood supply and scrotal integrity. Unlike open scrotal surgery, there is no risk to the vas deferens, epididymis, or testicular artery structures critical to fertility that can be inadvertently damaged during open dissection.
Male fertility IR procedure

Why Choose Interventional Radiology for Male Urological Conditions?

No Scrotal Incision

All procedures are performed through a tiny skin puncture in the wrist or groin the scrotum and groin are never cut.

Same-Day or Next-Day Discharge

Most procedures are completed as day cases. Patients return home within hours and resume light activities within 1–2 days.

Sexual Function Preserved

PAE and varicocele embolisation carry no risk of retrograde ejaculation, erectile dysfunction, or damage to the vas deferens.

Fertility-Focused Outcomes

Varicocele correction improves semen parameters in the majority of treated men, supporting natural conception and ART success rates.

Frequently Asked Questions

Varicocele is typically diagnosed by clinical examination (palpation of the scrotum) graded I–III by size, combined with colour Doppler scrotal ultrasound which confirms the presence and severity of venous reflux. Semen analysis and serum testosterone are performed to assess the impact on fertility and hormonal function. A venogram performed at the time of embolisation provides the definitive anatomical map.
Spermatogenesis the process of sperm production takes approximately 72–90 days to complete one full cycle. Meaningful improvement in semen parameters is therefore typically seen 3–6 months after embolisation. A repeat semen analysis is usually performed at 3 months and again at 6 months post-procedure. Couples should continue fertility investigations and treatment planning in parallel during this period.
This is one of PAE's most important advantages over TURP. Because PAE does not involve any instrumentation of the urethra or bladder neck, there is no risk of retrograde ejaculation a complication affecting 65–90% of men after TURP. Multiple published studies have confirmed that erectile function and ejaculatory function are preserved after PAE. Some men actually report improvement in sexual symptoms following relief of LUTS.
Studies consistently demonstrate prostate volume reduction of 20–40% over 3–6 months following PAE, with the maximum effect seen at around 6 months. This volume reduction translates to a clinically significant improvement in urinary symptom scores (IPSS), peak urinary flow rate, and quality of life. Very large prostates (100–200 ml) tend to show the greatest absolute volume reduction, making PAE particularly attractive for this group where TURP is technically challenging.
Both procedures use catheter-based access and can be performed separately at different time points, or staged appropriately based on clinical priorities. A comprehensive assessment with Dr. Shetty will determine the optimal sequence and timing. In younger men with both infertility and early BPH, addressing the varicocele first is typically prioritised, as it has the more immediate impact on fertility outcomes.
For varicocele embolisation: scrotal Doppler ultrasound at 3 months to confirm technical success, and semen analysis at 3 and 6 months to track improvement. For PAE: urinary symptom score assessment, uroflowmetry, and post-void residual measurement at 1, 3, and 6 months; MRI prostate at 6 months to assess volume reduction. Long-term, annual urological review is recommended to monitor for any symptom recurrence.
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