Procedures

A varicocele is an abnormal dilatation of the veins in the scrotum around the testicle. The veins enlarge because of reverse flow (reflux) in the testicular vein which drains the testicle. Normally the flow of blood from the testicle is upwards toward the heart and there are valves in the testicular vein which prevent flow back toward the testicle when standing (see figure 1). In about 15% of the male population these valves are missing or don't work properly allowing blood to flow back toward the testicle (see figure 2). Clinically the enlarged veins may be obvious as they cause one or both sides of the scrotum to appear distended. More subtle changes may only be detected by an ultrasound examination.

Treatment of a varicocele may be indicated because of discomfort or even pain due to the enlargement of the scrotum but the most common reason to seek treatment is infertility.

Varicocele is the most common cause of male infertility. The incidence of varicocele in the general male population is about 15% but approximately one third (19-41%) of infertile men have a varicocele. Men with this condition have a decreased sperm count and the sperm that are present show decreased motility (movement) and abnormal morphology (no tail, two heads etc.). These changes are probably due to elevated temperature in the testicle because of the abnormal venous blood flow.

Treatment of varicocele is aimed at the prevention of reverse flow in the testicular vein. Successful obstruction of the testicular vein results in improved semen quality in 71% of men within one year and 55% of those men become fertile. In the past this has been accomplished by surgically cutting and tying off the vein at the groin. This procedure may require hospital admission and one to two weeks recovery before returning to normal activity. Embolization of the vein is as effective as surgery but is less invasive, has lower morbidity and requires less time lost from work.

Over 1000 patients have been treated at TVI with no serious complication. No pre-operative medication is necessary. Under local anaesthetic, a small plastic catheter is passed from the common femoral vein to the testicular vein. A 1 mm catheter is then advanced through the first catheter into the testicular vein. Two or more stainless steel coils are deposited in the vein producing almost immediate obstruction (see figure 3). The procedure is painless except for the initial sting of the local anaesthetic. The patient is observed at TVI for one hour before discharge. He is instructed to avoid exertion that night, but can return to full activity the next day.