Varicocele Embolization Treatment for Dilated Blood Vessels in the Scrotrum

Leading cause of infertility in men for thousands of years is varicocele (Dilated blood vessels in the scrotum). 18 Hundreds of thousands of men in the United States undergo a surgical procedure to correct varicocele and elevate pain. Varicocele embolization treatment option for men's testicular varicose veins is less - invasive than standard surgical procedure, faster recovery period, and highly successful to treat infertility. 5 Males have an anatomical structure called the spermatic cord. Within the spermatic cord are veins, nerves, arteries and tubes that provide circulation of blood and connection to and from the testicles (testes or gonades: Male sex glands located behind the penis in a pouch of skin called the scrotum. The testicles store sperm responsible for fertility, and a source of male testosterone or hormones. 1).The veins in the spermatic cord transport blood to the heart. When valves inside the veins of the spermatic cord fail or stop flowing blood in the correct direction, a back-up leads to swelling and widening of the veins (dilated veins 3) or varicocele forms (Similar to varicose veins in the legs). Variocele mostly occurs during puberty and approximately in fifteen percent of males between 15 and 25 years old (According to the National Institute of Health 12). Kidney tumor in older men may cause varicocele or blockage of blood flow to a vein. 2 "A varicocele can develop in one testicle or both (both sides 20% 18), but in about 85% of cases it develops in the left testicle". 3 The symptoms of variocele is a dull pain or discomfort felt in the testicles (one side of the scrotum) and veins of the testicles are dilated (appear smaller) on one side. These symptoms are likely to be seen or felt after heavy exercise, during hot weather or when sitting or standing during long duration of time. Anti-inflammatory medication is prescribed to treat the symptoms of variocele. If medication does not relieve pain or variocele decreases sperm production (Interrupts fertility for a couple. 2 Symptom of variocele increase testicular temperature which detrimentally effects sperm production. 18), varicocelectomy surgery is recommended by urologists. 2 During an outpatient procedure, anesthesia is administered, and affected veins are tied off to redirect the flow of blood into other healthy veins. After surgery, ice pack is applied to the area reduce swelling and patients may wear a scrotal support recommended by the patient's physician. 2 During the recovery period (few weeks), pain medication maybe taken to relieve discomfort. About 72 days, sperm count generates to normal status, verified by semen analysis, confirms successful varicocele repair. 4

A non-surgical procedure called Varicocele Embolization performed by Interventional Radiologists is more beneficial compared to varicocelectomy surgery. 4 During the varicocele embolization patient is not under general anesthesia, instead given a local anesthesia ("twilight" sedation). "The Interventional Radiologists makes a small nick in the groin (about the size of a pencil lead), and a small tube (catheter) will be inserted in the groin (leg) or sometimes in the right side of the neck." 6 An x-ray imaging system helps the Interventional Radiologists guide the catheter in the venous system to the scrotum. A dye is administered which helps outline the blocked vein. 5 Once the obstructed vein is identified (flows blood backwards), tiny stainless steel metal coils and gelatin sponge slurry (Used to help stop bleeding 13) is inserted through the catheter to the problem area and removed. Subsequently the procedure resolves the abnormal blood flow. 7 Varicocele Embolization procedure proven to be successful when utilizing sclerosing coil and sodium tetradecyl sulfate foam (STS -when injected into a vein reaction of the blood vessel leads to its closure. 15), for the treatment of pain and infertility associated with varicoceles. 14 Robert White Junior M.D., international radiologist, study author and co-inventor of original non-surgical treatment for varicoceles in the United States said: "We expect the addition of foam will improve the embolization technique making it even more effective. The combination of foam and coils create a more complete blockage of the faulty veins which should help prevent a recurrence." 17 No stitches are required in the inserted area. "The Varicocele Embolization procedure takes approximately 1 - 1/2 hours to perform." After a few hours in the recovery room, patient goes home the same day. 5 After Varicocele Embolization 30 - 50% increase in pregnancy rates among couples that experienced infertility. However the procedure does no guarantee successful results for each case. 6

According to Amol Mujoomdar, M.D. of the University of Toronto Varicocele Embolization gives twenty-three percent of patients who had previously undergone unsuccessful surgical treatment successful outcome. Furthermore patients experienced no further or partial pain. Dr. Mujoomdar said: "We believe the procedure is good for both primary treatment and for so called surgical failures." 16

Advantages of Varicocele Embolization contrast to varicocelectomy surgery: When varicoceles occur on both sides, only one vein puncture site is necessary for the non-surgical Varicocele Embolization procedure. Varicocele open surgery increase the risk sometimes of infection, compared rarely to any adverse complication during the non-surgical procedure. Varicocele Embolization does not require cutting layers of tissue to expose the veins through an incision in the scrotum, compared to less invasive procedure using a laparoscope. 8 Approximately a twenty percent probability varicocelectomy surgery will not be successful because during the procedure some of the smaller veins may not be identified or missed for corrective results. According to anatomic studies, when varicocelectomy surgery is made through an incision in the abdomen (compared through the groin) a higher failure rate and higher recurrence rates occur because the procedure may miss some lateral drainage veins. 9 Studies have shown, recovery time after Embolization is faster, patients return to full activities in a day or two, compared to varicocele surgery patients must avoid rigorous or strenuous activity for several days or weeks after surgery. 10

The cost of varicocelectomy surgery compared to Varicocele Embolization procedure is approximately the same. However the cost does depend upon geographic location and patient insurance coverage. If the non invasive procedure is for fertility treatment, some insurance companies may limit the coverage. 10 A patient mentioned on the Web-site 'answerbag.com' cost $1,500 for the surgery, and his insurance coverage paid $1,350 (Balance paid by the patient). 11

References:

1.) Definition of Testicles - http://www.medterms.com/script/main/art.asp?articlekey=5745

2.) Varicocele - http://kidshealth.org/teen/sexual_health/guys/varicocele.html

3.) Varicocele - http://www.urologychannel.com/varicocele/index.shtml

4.) Varicocele - Treatments and drugs - http://www.mayoclinic.com/health/Varicocele/DS00618/DSECTION=treatments-and-drugs

5.) Men's Health Topics - Varicocele Embolization - http://www.doctorsinfoweb.com/men/varicocele.htm

6.) Varicocele Embolization - http://www.varicoceletexas.com/faqs.html

7.) Varicocele Embolization - http://www.hopeforfibroids.org/media-men%20varicocele%20embolization-kirsch.html

8.) Varicocele Embolization - A Treatment for Men's Testicular Varicose Veins - http://www.hopeforfibroids.org/media-men%20varicocele%20embolization-kirsch.html

9.) Varicocele Surgery Options: Vaicocelectomy - http://www.spryhealth.com/6

10.) Varicocele Repair - Frequently Asked Questions - http://www.varicoceles.com/faq.htm

11.) answerbag - Medical conditions and procedures - http://www.answerbag.com/q_view/139199

12.) Minimally Invasive Treatment Helps Infertile Couples Conceive - http://www.sciencedaily.com/releases/2006/11/061128140736.htm

13.) Treatments: UAE: Research Embolic Materials - http://www.igsapc.com/ute_fibroids/ute_art_embolization/emb_materials.htm

14.) Foam Product Relieves Painful Varicoceles: Presented at SIR - http://www.pslgroup.com/dg/2596e6.htm

15.) SCLEROTHERAPY WITH FOAM - http://www.southwestvein.com/sclerotherapy_foam.html

16.) medpagetoday.com - SIR - Varicocele Embolization Reduces Pain and Infertility - http://www.medpagetoday.com/MeetingCoverage/SIRMeeting/tb/8781

17.) newswise.com - Treatment for Male Infertility and Pain, & Chronic Pelvic Pain in Women - http://www.newswise.com/articles/view/519116/

18.) MaleReproduction.com - VARICOCELE - http://www.malereproduction.com/14_varicocele.html