About this patient information
This patient information tells you about having varicocele embolisation. It explains what is involved, the benefits, and possible risks. It is not meant to replace discussions between you and your doctor but can act as a starting point. If you have any questions about the procedure, please ask the doctor who has referred you or the Interventional Radiology department.
What is a varicocele?
A varicocele is a group of enlarged veins in the scrotum – the valves in the veins do not work properly and so the veins become bigger and more obvious, rather like varicose veins in the leg. Varicoceles may cause a heavy, dragging or aching pain, visible or prominent veins in the scrotum. They are sometimes diagnosed during the investigation of infertility and treatment may help your sperm count.
What is a varicocele embolisation?
Varicocele embolisation is a minimally invasive X-ray guided treatment, which blocks the enlarged vein(s) typically using metal springs (coils) and allows the veins to shrink over time.
Why do you need a varicocele embolisation?
There are a number of ways to treat varicoceles including open surgery, keyhole (laparoscopic) surgery and minimally invasive varicocele embolisation.
Your doctor may recommend varicocele embolisation if you have:
- Pain or discomfort in the scrotum
- A varicocele discovered during fertility investigations
- Recurrent varicocele after surgery
Who decides I need this procedure?
The consultant in charge of your care will have decided that this is the best option. However, you will have the chance to ask questions and decide whether to go ahead. You may decline the procedure at any point.
What are the risks?
Varicocele embolisation is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise.
Common/minor risks
- Bruising or soreness at the needle site. The bruise might be sore for a few days but will disappear in a few weeks
- Mild scrotal or loin discomfort for a few days
- Small skin-site infection, treatable with antibiotics
- Unfortunately, there is a possibility that your symptoms do not improve, or the varicocele may remain or come back. This can also happen after surgical treatment. If this happens, then your options can be discussed with your doctor
Uncommon risks
- Ongoing bleeding at the needle site which can lead to a short inpatient stay
- Temporary back pain if the vein wall is irritated
- Fluid around the testicle (hydrocele) (rare)
Rare risks
- Coil migration to the lungs (very rare). If retrieval is not possible, it usually causes mild, temporary symptoms (cough or mild chest pain for a few days)
- Failure to access the vein, meaning treatment cannot be completed. In that case your doctor will discuss your options with you
Contrast and radiation risks
- The dye (contrast agent) used during the procedure is very safe but occasionally can cause damage to the kidneys. This occurs mainly in patients whose kidney function is poor already and this will be identified on the blood tests that are performed before the procedure
- Allergic reactions to the dye or other medications are also possible but are very rarely serious
- During the procedure you will receive a dose of radiation as a result of the X-rays used. There is a possible risk of cancer induction from exposure to X-rays. However, we are constantly exposed to radiation from the air we breathe, the food we eat, the ground and from space. This is known as background radiation and has a cancer risk of around 1 in 10,000 per year. Having the procedure could result in you receiving an additional dose of radiation equivalent to a few years of background radiation. The associated risk of possible cancer induction from receiving a dose of radiation equivalent to a few years of background radiation is considered to be low. Your doctor has agreed that this procedure is the best examination for you compared with others and that the benefit of having it outweighs the risks from radiation.
If you need a magnetic resonance (MRI) scan in the future, you should tell the person doing the scan that you have had an embolisation.
Are you required to make any special preparations?
A varicocele embolisation is usually carried out as a day case procedure under local anaesthetic. You will be asked to attend the ward early in the morning so all required paperwork can be completed.
You may also be asked not to eat for 4 hours before the procedure, although you may take small sips of water if needed.
You may be sent a blood form and asked to arrange a blood test prior to the procedure to check your bloods are within safe limits to have the procedure.
If you take blood-thinning medication (e.g. warfarin, clopidogrel, Apixaban), you will be given instructions detailing if this medication needs to be stopped and for how long. If you have not been given this information, please contact the Interventional Radiology department. Unless advised otherwise please continue to take all other medication e.g. for blood pressure.
If you have previously had a reaction to the dye (contrast agent) or a local anaesthesia, please contact the Interventional Radiology department.
If you are a diabetic, you may be given instructions detailing if the medication you take needs to be stopped/altered following the procedure, and if you require additional blood tests.
You should have someone to drive you home following the procedure. Someone should be at home with you for 24 hours following the procedure. If you do not, please let the Interventional Radiology department know.
Who will you see?
A specially trained team led by an interventional radiologist who has special expertise in reading x-rays and x-ray guided procedures.
Where will the procedure take place?
In the Interventional suite, which is located within the X-ray department and is similar to an operating theatre.
What happens during embolisation?
- You will be asked to attend the ward early in the morning so all required paperwork can be completed.
- You will be asked to put on a hospital gown. A small cannula (thin tube) may be placed in your arm.
- Before the procedure, a member of the interventional team will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
- You will lie on your back on the procedure table. The X-ray machine will be positioned above you. You may have monitoring devices attached to your arm, chest and finger.
- The procedure is performed under sterile conditions and the team performing the procedure will wear sterile gowns and gloves.
- The skin on your groin, or occasionally neck, will be cleaned with antiseptic and you will be covered with sterile drapes. Local anaesthetic will be injected into the skin to numb the area.
- A small incision will be made, a needle, a wire and finally a catheter (fine plastic tube) will be inserted into the vein and guided, using the X-ray equipment, into the testicular vein.
- The interventional radiologist will block this vein usually by inserting small metal coils, which look like springs, these will remain in the vein. The radiologist will inject small amounts of dye (contrast agent) to check the position of the catheter and that the abnormal veins are blocked satisfactorily.
- Once the interventional radiologist is satisfied the catheter is removed and pressure applied to prevent bleeding.
Will it hurt?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine. Afterwards, some discomfort in the groin or scrotum is normal and usually settles within a few days.
How long will it take?
Every patient is different, and it is not always easy to predict, however, expect to be in the radiology department for about an hour.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations. Expect to:
- Stay flat initially, then gradually sit up and walk.
- Go home 4 to 6 hours after the procedure.
- Remove dressing as instructed.
- It can take several months for the swelling to shrink, so don’t worry if this takes longer than expected.
Recovery
- Pain: mild discomfort is common and managed with simple pain relief.
- Return to work: usually within 1 to 2 days (depending on the job).
- Exercise: avoid heavy lifting, strenuous exercise, and cycling for 1 week.
- Sexual activity: safe to resume when comfortable (usually a few days).
- Fertility: improvement, if expected, may take several months.
- It can take several months for the varicocele to shrink fully.
If you have any concerns after discharge; for non-urgent issues please contact your GP or 111, for urgent issues please come to A&E.
Finally, some of your questions should have been answered by this patient information but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Interventional Radiology:
Pilgrim Hospital: 01205 445486 Lincoln County Hospital: 01522 573266