What is a varicocele embolisation?
A varicocele is an abnormality of the veins that take blood away from the testicle. The veins become bigger and more obvious, rather like varicose veins in the leg. Embolisation is a way of blocking these veins, and therefore making them less obvious and causing the varicocele to disappear, without an operation.
Why do I need a varicocele embolisation?
Varicoceles can cause various problems, including infertility. In the past, an open operation would have been necessary to get rid of the varicocele, but now it can be treated by the technique of embolisation.
Who has made the decision?
The consultant in charge of your case, and the radiologist carrying out the varicocele embolisation, will have discussed the situation, and feel that this is the best treatment option. However, you will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.
Who will be performing the varicocele embolisation?
A specially trained doctor called a radiologist. Radiologists have special expertise in using x-ray equipment, and also in interpreting the images produced. The radiologist will look at these images while carrying out the procedure.
Where will the procedure take place?
Generally in the x-ray department, in a special ‘screening’ room, which is adapted for specialised procedures.
How do I prepare for varicocele embolisation?
You need to be an inpatient in the hospital for a short time. You will probably be asked not to eat for four hours beforehand, though you may be told that it is alright for you to drink some water. You will be asked to put on a hospital gown. If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), then you must also tell your doctor about this.
What actually happens during varicocele embolisation?
You will lie on the x-ray table, generally flat on your back.You may also have a monitoring device attached to your chest and finger. The radiologist will keep everything as sterile as possible, and will wear a theatre gown and operating gloves. The skin near the point of insertion, which is usually the right side of the neck, will be swabbed with antiseptic, and then most of the rest of your body covered with a theatre drape. The skin and deeper tissues over the vein will be anaesthetised with local anaesthetic, and then a small needle will be inserted into the vein at the bottom of your neck. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into the vein. Then the needle is withdrawn allowing a fine plastic tube, called a catheter, to be placed over the wire and into the vein. The radiologist uses the x-ray equipment to make sure that the catheter and the guide wire are moved into the right position, into the varicocele, and then the wire is withdrawn. The radiologist can block the abnormal veins by passing down small metal coils. These metal coils are like small springs, and cause the blood around them to clot, and consequently block the vein. The radiologist will inject small amounts of special dye, called contrast medium, down the catheter, to check that the abnormal veins are being blocked satisfactorily. Once they are blocked completely, the catheter will be removed. The radiologist will then press firmly on the skin entry point for a few minutes, to prevent any bleeding.
Will it hurt?
When the local anaesthetic is injected, it will sting a small amount initially, but this soon passes, and the skin and deeper tissues should then feel numb. After this, the procedure should not be painful. There will be a nurse, or another member of staff, standing next to you and looking after you. If the procedure does become uncomfortable for you, then they will be able to arrange for you to have some painkillers through a needle in your arm (although this is very unlikely). You will be awake during the procedure, and able to tell the radiologist if you feel any pain, or become uncomfortable in any other way.
How long will it take?
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about 15 minutes, but you may be in the x-ray department or theatre for an hour.
What happens afterwards?
You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no untoward effects. You will be able to go home after about half an hour as long as you feel well.
Are there any risks or complications?
Varicocele embolisation is a very safe procedure, but there are some risks and complications that can arise. There may occasionally be a small bruise, called a haematoma, around the site where the needle has been inserted, and this is quite normal. If this becomes a large bruise, then there is the risk of it getting infected, and this would then require treatment with antibiotics. Very rarely, some damage can be caused to the vein by the catheter, and this may need to be treated by surgery or another radiological procedure. Unfortunately, there is always the possibility that although the varicocele seems to have been cured to start with, months or even years later, it may come back again. If this happens, then the procedure may need repeating, or you may be advised to have an operation. Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side-effects at all.
Some of your questions should have been answered by this information, but remember that this is only a starting point for discussion about your treatment with the doctor looking after you. Do satisfy yourself that you have received enough information about the procedure, before you sign the consent form.