Dr. Raman Tanwar

Urologist and Andrologist

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 and embolisation.

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 or available as surgery. It is only done in large centres with ICU backup.

After embolization, you can often return to work after two days, and begin exercising as soon as your doctor allows for the fear of coil migration.

Comparison between Microsurgery and Embolization

Microscopic SurgeryEmbolization
Recovery time is 24-48 hours.Recovery time is 24 hours.
The patient can resume physical activity after 2-3 days.The patient can resume physical activity after 2-3 days.
After a surgery, resuming sexual intercourse can take about 2 weeks.The patient can have intercourse after 2 weeks.
It has the highest success rate of nearly 98%The success rate of embolization is 90%. Recurrence rates are higher.
https://pubmed.ncbi.nlm.nih.gov/26658060/
Very small scar that is not even visibleA hole is made into your blood vessel
Stay for 2-4 hours (In our centre)Stay for 6-8 hours (as it is done in a bigger setup where discharge takes time)
Lowest Complication ratePotentially Serious complication rates
https://pubmed.ncbi.nlm.nih.gov/26658060/
Good for all grade III and IV varicoceleCareful patient selection is needed for high grade
Cost is much less than EmbolizationCost is higher than Microsurgery
Better results in case of InfertilityEmbolization results were inferior with regard to natural pregnancy rates
https://pubmed.ncbi.nlm.nih.gov/18772487/
Better resolution of pain as nerves are also cut.Poorer resolution of pain as Pain is seldom due to just the varicocele.
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
  • Higher Recurrence rate

However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus.

Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 2016 Mar-Apr;18(2):234-8. doi: 10.4103/1008-682X.169985. PMID: 26658060; PMCID: PMC4770492.

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 and more easily available than microsurgery.

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 and more threatening complications.

Last updated on 25th September 2023.

Varicocele Surgery or Embolization?