MALE  VARICOCELE  OCCLUSION

Varicoceles may be diagnosed with scrotal ultrasound and are often asymptomatic.  (photo shows a color flow ultrasound image of a prominent varicocele.)
 

Background

Varicoceles (dilations of the scrotal venous plexus) are found in 10 to 15 % of the male population and they occur predominantly on the left side. The cause may be a longer left spermatic vein with its right - angle insertion into the left renal vein and/or absence of valves, which results in a higher pressure in the left spermatic vein causing dilatation. The incidence of varicocele in men with impaired fertility is about 30%; varicoceles are the most common correctable cause of male infertility. Varicoceles may also cause chronic scrotal pain or discomfort. A clinical grading system classifies varicoceles into three grades: grade 1 (small) - - palpable only during a straining maneuver, grade 2 (moderate) - - palpable without the need of the straining maneuver, and grade 3 (large) - - visible.

Although varicoceles can be diagnosed by a thorough physical examination, ultrasonography is the most practical and accurate non - invasive method in diagnosing this condition. Surgical ligation (varicocelectomy) is the conventional approach in managing varicoceles. This is an outpatient procedure involving a small scrotal incision followed by tying off the enlarged veins.

However, non-surgical embolization by means of balloon or metallic coil has been shown to be a safe and effective alternative to ligation in treating varicoceles. The procedure is performed as an outpatient. The groin or neck is washed and numbed before a tiny nick is made in the skin. A small plastic tube is advanced into the abnormal vein using x-ray guidance. The vein is then occluded, usually with small metallic coils. Patients are observed up to a few hours before going home, and often may return to work the next day. Embolization of varicoceles in males with semen abnormalities has been demonstrated to improve sperm count and motility in up to 75% of patients, and reported pregnancy rates after ablation of varicoceles vary from 30 to 60%.

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