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.