Varicocele Surgery or Embolization?

Men suffering from varicoceles have options when considering treatment. Previously, surgery was the only way you could treat these varicose veins of the scrotum. Recent medical advances have allowed men to choose between surgical treatment and embolization, a minimally invasive alternative to surgery. But this treatment method has its own problems and risks. Lets read more to understand this better

What are the Surgical Options for Varicocele Treatment ?

Surgery is a method in which varicocele is treated by surgical methods. There are three surgical methods as follows :

  • Laparoscopic: This method is performed through small incisions are made and a thin, lighted tube or scope is inserted. Medicine is given to prevent blood clotting. To keep the patient pain free, general anesthesia is given. It puts you into a deep sleep and no pain is felt. The abdomen is filled with gas which makes space for the doctor to see and work.
  • Open surgery: It is usually performed under local or general anesthesia. The surgeon makes an incision at either the upper scrotum, groin, or lower abdomen. Advancements have been made in surgical methods like using a microscope to see the treatment area better during surgery and another advancement is the Doppler ultrasound. Pain from open surgery is usually mild but may continue for weeks. Recovery takes about 2-3 weeks in surgical methods. And your doctor may advise not to have sex for a period of time. Most often, it will take several months after surgery before improvements in sperm quality can be seen with a semen analysis. This is because it takes approximately three months for new sperm to develop.
  • Microsurgery: A surgery performed using a microscope. The procedure is complex but has less complications and less recurrence rate than open surgical method.

What is Embolization for Varicocele ?

Varicocele embolization is a minimally invasive outpatient procedure that only requires local anaesthesia. A radiologist inserts a tube into a major vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure isn’t as widely used as surgery.

After embolization, you can often return to work after two days, and begin exercising after a month.

Comparison between Microsurgery and Embolization

Microscopic SurgeryEmbolization
Recovery time is 48 hoursRecovery time is 48 hours
The patient can start exercising and resume physical activity after 10-14 days.The patient can resume his physical activity after 7-10 days
After a surgery, resuming sexual intercourse can take about 4 weeks.The patient can have intercourse after 2 weeks.
It has the highest success rate of nearly 95%The success rate of embolization is 90%.
Very small scar that is not even visibleA hole is made into your blood vessel
Stay for 2-4 hoursStay for 6-8 hours
Lowest Complication rateHigher complication rates like coil migration, recurrence and increase in grade
Good for grade III and IV varicoceleLess effective for high-grade Varicocele
Cost is one-third of EmbolizationCost is three times higher than Microsurgery
Comparative table between Varicocele Microsurgery and Embolization

Open microsurgical inguinal or sub-inguinal varicocelectomy led to the fewest recurrences, which they attributed to the ability of the surgeons to visualize and ligate all spermatic veins with the higher magnification

Based on Scientific research and review of all existing publications on Varicocele treatment from across the world
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770491/

Advantages of Embolization

It is a daycare procedure that does not require a cut over the skin. It requires a more sophisticated fluoro imaging suite.

Disadvantages of Embolization

It is a more costly procedure that has unique risks like :

  • Injury to major blood vessels
  • Allergies due to use of dyes leading to kidney damage
  • Coil Migration
  • Failure of ligation
  • Higher Recurrence rate

The Last word

Looking at the available research we can suggest that embolisation is an alternative to microsurgery but it is not better than microsurgery. Subinguinal microscopic varicocele repair is the gold standard treatment of varicocele repair across the world.

Embolisation is also more expensive and risky as it involves handling the main blood vessels of the body and subjects the patient to some unique complications.

Cost of Penile Implant in Delhi India

Every year hundreds of patients with erectile dysfunction from across the globe look at Delhi, India for a high-quality low budget penile implant surgery. Everyone has different requirements and budgets and eventually, everyone finds a reasonable solution. The cost for penile implant surgery in Delhi, India starts at INR 85000 for a malleable Indian Implant. As the quality of the implant improves, so does the cost of surgery. Usually, the cost of Surgery includes:

  • Admission and room rent charges
  • Surgery Charges
  • Drugs and Consumables
  • Operating Suite Charges
  • Sterilisation charges
  • Implant Procurement and Handling charges
  • Doctor Visit Charges
  • Medical Officer Visit Charges
  • Nursing Charges
  • File and Registration Charges

Pre-anesthesia clearance, Initial consult, and charges of any prior test such as doppler, office Bimix test and other investigations are not a part of this package. All oral medications are also to be purchased separately by the patient.

The charges undergo regular revision and the final charges may vary from those mentioned in this website. The routine cost for other implants will be as follows:

Coloplast Genesis Malleable implant cost in Delhi, India is INR 200,000

2 piece AMS Ambicor Inflatable penile implant cost in Delhi, India is INR 500,000

3 piece AMS700 CX Inflatable penile implant cost in Delhi, India is INR 750,000

3 piece AMS700 CXR Inflatable penile implant cost in Delhi, India is INR 780,000

3 piece AMS700 CXR Inflatable penile implant cost in Delhi, India is INR 820,000

Is Stapler Circumcision really better than standard circumcision?

Male Circumcision is one of the most commonly performed surgeries in the world. Dr. Raman Tanwar performs a circumcision when it is medically indicated or when a consenting adult approaches him for this procedure. Stapler circumcision is a new way to perform this age-old procedure. The world over this procedure is typically done on new-borns for personal or religious reasons. In new-borns, there is no medical need for Circumcision but the religious laws of both Judaism and Islam require that new-born be circumcised. Associated myths include:

  • It affects the sexual pleasure of a man.
  • It produces effects on Male Fertility.

These myths are absolutely false.

Circumcision is done in older children and adults to treat several conditions;

  • Infections of the glans and foreskin such as Balanitis and Balanoposthitis
  • Phimosis
  • Paraphimosis

Methods of performing Circumcision

There are three techniques by which circumcision can be performed. The most commonly used and trusted technique is standard circumcision in which the foreskin is removed with the help of scissors and self-dissolving stitches. The stapler circumcision is another way of performing circumcision. In this technique, the foreskin is cut using a stapling device which also stitches the wound with the help of fine stainless steel staples. Nowadays LASER is also frequently used to perform circumcision in which laser energy is used to cut the foreskin and self-dissolving stitches are placed.

  • Standard Circumcision
  • Stapler Circumcision
  • Laser Circumcision
  • Other techniques: Plasti-bell Circumcision, Gomco Clamp Circumcision, Sham ring Circumcision

Is stapler circumcision better ?

To answer this question let us understand what the circumcision stapler is. The Circular stapler, a new disposable circumcision device, has been developed to perform circumcision. It includes two parts: 

  • an Inner bell 
  • an Outer bell

The inner bell is designed to protect the glans. The outer bell comprises a circular blade to cut the foreskin and staples to close the wound for simultaneous hemostasis.

Raman-tanwar-urologist-andrologist-best-gurgaon-gurugram-sexologist-prostate-kidney-stone-jyoti-top-urocentre-stapler-ZSR-painless-circumcision
The disposable circumcision stapler is a new device that is used to perform circumcision but this technology has its own pitfalls which a patient must understand before choosing this technique

The Disposable circumcision stapler is sterile, hand-held, manual surgical instrument preloaded with non-bioabsorbable skin staples intended to be used to perform a circumcision. It is designed to cut the foreskin and apply a circular row(s) of staples proximal to the cut line. The stapler portion typically consists of a dome intended to be inserted under the foreskin over the glans penis, and a circular cutting stapler mechanism with a manual lever intended to connect over the outside of the foreskin. You can read more about how stapler circumcision is done here.

Advantages of Stapler Circumcision

  • Short operative time of just 5 minutes compared to 10-12 minutes of standard circumcision.
  • Minimal pain and tissue injury, and a low blood loss volume. Therefore, the stapler also has the potential to be used in high-volume settings by health care providers with minimal training and experience because of its simplicity and short operative and recovery times.
  • More uniform suture line as cutting is done by a surgical circular blade which is a part of the stapling device.

Disadvantages of Stapler Circumcision

More expensive and latest technology may not always be better. It may have its own place and some advantages but it has a separate set of limitations as well

  • The main disadvantage of the Stapler is that there may be a need to remove Residual staples after surgery. Ideally, the staples used for incisional closure need to fall off spontaneously, however, sometimes, they don’t fall off, as a result, the surgeon needs to remove them.
  • It is not a Standard Male Circumcision technique and we have more data on standard circumcision and its long term complications.
  • The stapler has a fixed diameter that cuts in a particular shape thus circumcision cannot be customized when using a stapler
  • It is not able to use a stapler when there are a lot of abnormal preputial adhesions
  • It is a relatively costly procedure since it is a single-time usable Device and the cost of the device is added.
  • The stapler device is currently available in a limited range of sizes, thus, limiting its application in patients with Abnormal penis sizes and in children.

Is Stapler Cirumcision better ? Final Verdict

Stapler circumcision is just another means of performing circumcision. It offer advantages in terms of quick surgery and maybe a finer line of cut but in the hands of an experiences surgeon like Dr. Raman Tanwar who has an experience of more than 5000 circumcision procedures over more than a decade of practice, standard circumcision is equally effective especially when your case may be more difficult than usual.

If you would like to book a circumcision procedure with Dr. Raman Tanwar, who is known for the best circumcision service in Gurgaon and Delhi NCR region you can book his consultation here.

Best Urologist in Gurgaon

best urologist in gurgaon Dr. Raman Tanwar

If you are looking for the best urologist in Gurgaon you need to look at not just academic qualifications but the knowledge, skills, and nature of the urologist you are consulting. Dr. Raman Tanwar is a well-renowned urologist of international repute and fame. Here are a few things that make Dr. Raman Tanwar one of the best urologists in Gurgaon and Delhi NCR region:

5 Gold Medals in Urology

Dr. Raman Tanwar has received 5 gold medals in Urology for all aspects such as knowledge (two gold medals for highest marks in the university and college), research (two gold medals, and a silver medal for outstanding research) and academic contributions. Know more about his academic achievement and awards.

Internationally and Nationally Awarded

Dr. Raman Tanwar has achieved laurels that only a handful of Indian doctors have achieved. He has been awarded by associations such as the British Medical Association, International Society of Sexual Medicine, European Association of Urology, International Society of Men’s Health to name a few apart from numerous national and local organizations.

Highly Rated as Best Urologist by patients

After a fair review of patient satisfaction on various portals that feature urological care specialists you will find that Dr. Raman has the highest ratings when it comes to patient satisfaction and rewarding patient experience. As per statistics Dr. Raman Tanwar is the best urologist in Gurgaon with highest 5 star ratings.

Medical Author and Researcher

Dr. Raman Tanwar is the national author for guidelines on male sexual dysfunction and infertility. These are the guidelines that all urologists in India follow. You don’t just need a standard doctor with standard treatment to deal with your condition in the best possible way, you need someone who can provide the latest and customized treatment. This is where the unique talents of Dr. Raman Tanwar as an author and researcher can help you. Since Dr. Raman Tanwar is always abreast of the latest scientific advances, you can rely on him for the latest available treatment of your condition.

Unique Continuum of Patient Care via PROCLINIC

Dr. Raman Tanwar is the only urologist in India who has devised his own system of patient care through a unique technology-based patient interaction system called Proclinic. This means that he is available for further discussion even after you have left his office. There is a system through which you can update your reports and everything. It’s a new level inpatient care altogether. You can chat directly with Dr. Raman if you are an old patient of his at this link.

Apart from these top reasons why you should be choosing Dr. Raman Tanwar as the best urologist in Gurgaon, there are many other reasons why you should definitely consult Dr. Raman before you decide to get treatment through any other urologist. Dr. Raman is an authority in Urology and Andrology with a large following of international patients, posts of regard in the Urological Society of India (the apex body of urologists of India). He trains and teaches fellows from across the globe in the art of Urology and Andrology.

If you would like to book your appointment with Dr. Raman Tanwar please click here. It will be worth the wait and effort.

IMA Tiger Award

The Indian Medical Association launched the Mens Health program under its banner and awarded doctors who have contributed to Mens Health in India. On this occasion Dr. Raman Tanwar adressed an elite gathering of doctors and introdced the concept of Mens Health to all. He was awarded by the President of the IMA Dr. Ravi Wankhedkar with the IMA Tiger National Award.