Varicocele Embolization in Lucknow

A varicocele is a group of enlarged veins in the scrotum, above and behind the testicle. The valves in the testicular vein fail, blood flows backwards and pools, and the veins widen.

It is common in young and middle-aged men. It appears on the left far more often than on the right, because of the way the left testicular vein drains into the kidney vein. Many men have one and never know.

• A dull ache or dragging heaviness in the scrotum, worse after standing or exercise and easier lying down.
• A soft swelling that feels like a bag of worms, mainly when you stand.
• One testicle that looks smaller than the other.
• Difficulty conceiving, found when a semen test shows a low count or poor movement of the sperm.

A varicocele that appears suddenly, sits only on the right, or does not shrink when you lie down is looked at more carefully. Occasionally something in the abdomen is pressing on the vein.

A scrotal Colour Doppler scan shows the widened veins and whether blood flows backwards in them. It is done lying down and again standing, or while you strain gently, because that brings out the backward flow.

It also measures both testicles, checks the other structures in the scrotum and looks for a lump or a fluid collection that could explain the symptoms. Small-parts scans are described on our general ultrasound page, and the team confirms the scrotal Doppler when you book. No radiation is involved.

Embolization closes the faulty vein from the inside, so blood stops pooling in the scrotum. A radiologist passes a very thin tube, called a catheter, through a small puncture, usually in a vein of the groin or neck. The tube is guided down to the testicular vein on live imaging, and a little contrast dye, which shows up on the pictures, reveals where blood is flowing backwards.

Tiny metal coils, sometimes with a sclerosant liquid or a plug, are then placed to block that vein. Blood drains through other veins instead. The puncture is only a few millimetres wide, so there is no cut to stitch. Local anaesthetic is usual, sometimes with sedation, and the team doing the procedure explains the plan before the day.

Treatment is considered when a varicocele causes ongoing pain, when a teenager's testicle on that side is not growing as well as the other, or when a man has abnormal semen results and the couple wants a child. A varicocele without symptoms and with normal semen tests usually needs no treatment.

Embolization is one of several choices.

• Observation with a check from time to time, which suits most men without symptoms or fertility concerns.
• Embolization, which uses a small puncture and no incision.
• Surgery, where the veins are tied off through a small cut in the groin or lower abdomen, sometimes with the help of a microscope or telescope.

A scrotal support and simple pain relief can ease the ache meanwhile. A urologist or fertility specialist usually helps to choose between these options, and the choice is yours as well.

Embolization can reduce the ache and may improve semen results in some men, but nothing about the result is certain. Sperm quality can stay the same, and pregnancy depends on many other things, including your partner's health and age. Semen tests are usually repeated after about three months, because sperm take that long to renew.

The risks are explained before you consent.

• Bruising, soreness or a small lump where the tube went in.
• Tenderness along the treated vein and a mild fever for a day or two, as the vein reacts.
• Allergy to the contrast dye, and extra strain on the kidneys in people with kidney disease.
• The varicocele returning or not settling fully, because other small veins may carry the blood back.
• Rarely, a coil moving from its place, injury to the vein, or infection.
• A small dose of radiation from the imaging, which is kept as low as practical.

Suitability is decided from the scrotal scan, your symptoms, your semen reports and any urology notes. The urologist or fertility specialist who sent you has a say, and so do you.

We look at the referral, semen reports and scan first. After that review the team confirms whether embolization is carried out at our centre or elsewhere, and who will perform it. Please do not plan travel or time off before you have that confirmation. Other interventional radiology procedures are listed on their own page.

Embolization may not be suitable after a serious reaction to contrast dye, or with an active infection or a bleeding problem. It may also be unsuitable if the vein anatomy makes the target hard to reach. The radiologist judges this from the images.