Possible Treatment
Varicocelectomy, the surgical correction of a varicocele, is performed on an outpatient basis. The three most common approaches are inguinal (groin), retroperitoneal (abdominal), and infrainguinal/subinguinal (below the groin). Various other techniques may be used. Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling. The patient may be advised to wear a scrotal support for some time after surgery.
Possible complications of this procedure include hematoma (bleeding into tissues), hydrocele (accumulation of fluid around the affected testicle), infection, or injury to the scrotal tissue or structures. In addition, injury to the artery that supplies the testicle may occur.
In the Gat-Goren nonsurgical method for treating varicoceles, performed under local anesthesia, a catheter is inserted through a vein in the upper thigh. Fluid injected through the catheter selectively closes off the malfunctioning veins, thus enabling the testicular tissues to recover and begin to produce normal sperm in normal amounts. The procedure lasts one to two hours and causes almost no discomfort. The patient can return to his regular routine in about 5 days.
An alternative to surgery is embolization, a minimally invasive treatment for varicocele that is performed by an interventional radiologist. This involves passing a small wire through a peripheral vein and into the abdominal veins that drain the testes. Through a small flexible catheter, the doctor can obstruct the veins so that the increased pressures from the abdomen are no longer transmitted to the testicles. The testicles then drain through smaller collateral veins. The recovery period is significantly less than with surgery and the risk of complications is minimised with overall effectiveness similar to surgery, yet with fewer recurrence rates.
Embolization is an effective treatment for post-surgical varicoceles. These are varicoceles that reappear after they have been surgically repaired. The main theory is the presence of redundant gonadal veins that provide collateralization cause the reappearance of the varicoceles. The use of NBCA glues during the embolization is as effective at embolizing these collaterals as coils.
Medical treatment with L-carnitine has some beneficial effect on sperm parameters, but is not as effective as surgery. Micronised purified flavonoid fractions (MPFF) have a beneficial effect on reducing varicocele pain and reducing reflux time of left spermatic vein during the Valsalva maneuver.
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