About varicocele

Varicocele (pronounced “varico-seal”) can be thought of as varicose (swollen or twisted) veins in your scrotum.  A varicocele is not, in itself, dangerous.

Your testis is drained by a large number of little veins in your scrotum which merge into one or more bigger veins. These testicular veins pass upwards and take blood back towards your heart. They are elongated (‘stretched’), extending all the way back up to the level of your kidneys. Because of their length, they are prone to becoming varicose. If this happens, the venous valves fail to work properly and this causes the veins to become swollen due to gravitational effect and slow flow.

If you have a varicocele you may experience a dragging sensation and feel some swelling around the testis. This is often described as a “bag of worms”.

Why we treat varicocele

Our main reason for treating a varicocele is if it causes you significant discomfort.

Some men are referred to us for treatment because of primary infertility (low sperm counts).  This is because there is some evidence that the presence of a varicocele keeps the testis too warm and may depress sperm production. This theory has not been proven in a controlled trial, but varicocele embolisation is often considered a reasonable option to try and improve sperm counts.

Why you need varicocele embolisation

The doctor in charge of your case and your interventional radiologist both feel this is the best treatment option for you. 

Your doctors will discuss their recommendation with you and they will take your opinion into account. You will have the chance to ask questions.  If, after discussion with your doctors, you do not want us to carry out the procedure, you can decide against it.

We will only go ahead with this procedure after you have given us your written consent.

About embolisation 

A therapeutic embolisation means we deliberately block an artery or vein to prevent blood flow through it. In the case of varicocele embolisation, we block your testicular vein with platinum coils, preventing blood refluxing (flowing back) into your scrotum. This allows the varicocele to shrink.

The platinum coils remain in your body but are unable to move and are biologically safe. They do not set off metal detectors at the airport.

Who performs the embolisation and where it takes place

Your embolisation will be performed by a consultant interventional radiologist and a doctor who specialises in performing percutaneous (through the skin) procedures under imaging guidance.  They are experienced in manipulating catheters and guidewires deep inside the body, using X ray and scanning equipment.  They use the images on screen to guide the procedure and place the coils accurately within your testicular vein.

They will perform the procedure in the Interventional Screening Room, part of the Kingston Hospital Radiology Department.

Preparing for your procedure

You will have the procedure as an outpatient and we will ask you to attend the Kingston Hospital Interventional Unit (within the Radiology department) on the day of the procedure.

To prepare for the procedure, do the following.

  • You can take sips of water up to 2 hours before the procedure.
  • You can take your normal medicines up until the procedure.
  • When you receive your appointment letter, tell the Interventional Radiology Unit if you have previously had allergies to foods, medicines or intravenous contrast medium (the dye used for kidney X rays and CT scans).
  • When you receive your appointment letter, tell the Interventional Radiology Unit if you have been on blood thinning tablets such as warfarin, aspirin or clopidogrel.

If you are an outpatient

You must have a responsible adult go home with you.
You must also have a responsible adult to stay with you for 24 hours (including overnight).

You can expect the following during the procedure.

The consultant interventional radiologist will meet you, answer any questions you may have and ask you to sign a consent form so that we can carry out the embolisation.

  • Once you have changed into a hospital gown, we will ask you to lie on the X ray table.
  • We will make sure you are as comfortable as possible before continuing. We will wrap a cuff around your arm to monitor your blood pressure and put a clip on your finger to measure your pulse and breathing.
  • We usually perform the procedure via a vein in the groin.  Sometimes we perform it via a vein in the neck.
  • Whichever site we choose, we clean your overlying skin with antiseptic and anaesthetise it with a local injection.
  • The radiologist will introduce a needle into the vein and, using a guidewire, they will exchange it for a thin plastic tube called a catheter.
  • With the catheter now in the vein, we will inject X ray dye to allow us to obtain a map of your veins.
  • The X ray dye can cause a warm, glowing feeling but this passes quickly and is not painful.
  • Using the map, we will move the catheter into your testicular vein and release 1 or 2 platinum coils to cause a blockage.  Sometimes we also use a little glue.
  • Once the radiologist is satisfied with the result, we will remove the catheter and apply pressure to the skin entry point for several minutes.  We do this to prevent bleeding.

Pain

During the procedure you may be aware of some unusual tickling inside your tummy as the catheter moves around.

You may experience a little discomfort as the coils are deployed but this will lessen quickly and cease over the next 24 hours.

The local anaesthetic will deaden sensation at the catheter entry site, but will not take away all discomfort.

As the anaesthetic wears off, you may feel somewhat bruised.  Over-the-counter paracetamol can help with this.

How long it takes

Every patient’s situation is different, but the procedure usually takes about 1 hour.

After the procedure

We will ask you to rest in our Radiology Recovery Ward for 2 hours immediately after the procedure.

If you recover well and have someone with you to take you home, we will discharge you.

At home you need to rest quietly until the following morning.

The next day you can resume your usual activities, except for vigorous sport.

Risks

Varicocele embolisation is a safe procedure.  We usually perform it without any significant side effects for the patient, but there are some risks.

  • The main risk is of the misplacement of the embolisation coils. This is rare because we do not perform the procedure if the operator is unable to get the guiding catheter into the right place. In this situation, we refer you back to your urologist and offer you a simple surgical operation to remove the varicocele.
  • It is possible for some people to be allergic to X ray dye, but significant reactions are rare because of the sophisticated types of dye we use.
  • You may have a small bruise where we have removed the catheter.
  • There may be significant damage to the vein or adjacent artery which requires surgical repair.  This is rare.
  • It is possible for your varicocele to return months or years later, even though we have cured it.  If this happens, we may repeat the procedure or advise you to have an operation.

If you have concerns or questions about this procedure, you can discuss these with your medical team and your interventional radiologist at any time.

Contact information

Interventional Radiology Unit
 

Interventional Radiology Unit Charge Nurse​​​​​​​

Telephone:

Interventional Radiology Unit: 020 8934 6206

Interventional Radiology Unit Charge Nurse: 020 8934 2758