Varicocele Embolisation
A varicocele is similar to varicose veins in the legs, but it occurs when the veins inside the scrotum become enlarged. Around 10–15% of men have a varicocele.
What is the normal anatomy?
The male reproductive system makes, stores, and moves sperm. The scrotum is the sac of skin that holds the testicles. Sperm and the hormone testosterone are made in the testicles. Sperm travel to the prostate from each testicle via the epididymis and vas deferens. When you ejaculate, seminal fluid mixes with sperm in the prostate to form semen, which then passes through the urethra and out of the penis.
The spermatic cord holds the vas deferens and the testicular artery, which brings blood to the testicle. It also contains the pampiniform plexus, a network of veins that drains blood from the testicles and helps cool the incoming arterial blood. This temperature regulation is important for sperm production.
What are Varicoceles?
A varicocele occurs when the pampiniform plexus veins in the scrotum become enlarged, similar to varicose veins in the legs. They usually develop during puberty and may grow larger or more noticeable with time. Varicoceles are more common on the left side of the scrotum.
Most varicoceles cause no problems and are harmless. In some cases, however, they may lead to pain, infertility (difficulty fathering a child), or slower growth/shrinkage of one testicle.
How are varicoceles diagnosed?
Varicoceles are often detected through self-examination of the scrotum or during a routine doctor’s examination. They are commonly described as feeling like a “bag of worms”.
Your GP or urologist may arrange an ultrasound scan of the scrotum to assess the size of the veins and testicles.
What are the treatment options?
There is no medication that cures varicoceles, although painkillers may help relieve discomfort.
The two most common treatment options are:
- Surgery – Surgical approaches include retroperitoneal (laparoscopic), infrainguinal/subinguinal (below the groin), and inguinal (groin). Possible complications include haematoma (bleeding into tissues), hydrocele (fluid around the testicle), infection, or injury to scrotal structures. Damage to the artery supplying the testicle may also occur, which in rare cases can lead to loss of the testicle.
- Varicocele Embolisation – A minimally invasive, specialist procedure performed by an interventional radiologist. It is usually a day case, carried out under local anaesthetic through a tiny (around 2 mm) incision in the neck or groin. Most patients can return to normal activities within a few hours.