Centers of Excellence in Interventional Cardiology and Radiology

Gentleman

Varicocel Embolization

PROCEDURE WITHOUT SURGERY , 24 HOURS AFTER DISCHARGE!

So far he has treated more than 10.000 cases of benign prostatic hyperplasia!

The most modern equipped angiography room , an exceptional medical team

The simplest method of treating the varicocel!

Only 24 hours hospitalization

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Generalities

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A varicocele is an abnormality of the veins that take blood away from the testicles. The veins become bigger and more obvious, that may cause pain and lead to testicular atrophy (shrinkage of the testicles).

In healthy veins within the scrotum, one-way valves allow blood to flow from the testicles and scrotum back to the heart. In a varicocele, these valves do not function properly, causing blood to pool enlarging the vein around the testicle in the scrotum causing a varicocele. Some experts believe that the raised temperature that results from the pooled blood in these blocked veins can decrease sperm count and motility of sperm and increase the number of deformed sperm. In fact, the incidence of varicoceles increases to 30 percent in couples who cannot have children.

How Common is this affection?

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Approximately 10 percent of all men have varicoceles.

Among infertile couples, 30 percent of men have varicoceles.

The highest occurrence of varicoceles is in men ages 15–35.

95 percent of varicoceles are found on the left side of the scrotum.

Symptoms

Pain: Men who experience pain in their testicles—particularly when exercising, standing or sitting for a long period of time—may be suffering from varicoceles. Typically, painful varicoceles are prominent in size. If left untreated, varicoceles may lead to infertility.

Fertility problems: There is an association between varicoceles and infertility. Decreased sperm count, decreased motility of sperm and an increase in the number of deformed sperm are related to varicoceles. As we pointed above, some experts believe these blocked and enlarged veins around the testes cause infertility by raising the temperature in the scrotum and decreasing sperm production.

Testicular atrophy: The shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired, it will return to normal size.

Diagnostics

Varicoceles are simple to detect and diagnose through physical or diagnostic examination.

95 percent of varicoceles are found on the left side of the scrotum.

The scrotum looks like a bag of worms.

The testicles may be shrunken in size.

If varicoceles are not detectable through the above criteria, abnormal blood flow can often be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram—an X-ray in which a special dye is injected into the veins to “highlight” blood vessel abnormalities.

Indications

There are both nonsurgical and surgical options available.

1. Open surgical ligation – performed by a urologist, is the most common treatment for symptomatic varicoceles. In this procedure, an incision is made in the skin above the scrotum down to the testicular veins, which are tied off with sutures. Patients of open surgical ligation can expect a two- to three-week recovery period.

2. Varicocele embolization – a nonsurgical treatment performed by an interventional radiologist, is as effective as surgery with less risk, less pain and less recovery time.

Procedure

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Varicocele embolization (also called catheter-directed embolization) is a nonsurgical treatment performed by an interventional radiologist that is a highly effective, widely available technique to treat symptomatic varicoceles.

The procedure is performed in a room that has a special x-ray machine called an ‘angiography suite’ or fluoroscopy room. It is done under local anesthesia. You may receive a sedative to relieve anxiety. Thus, after local asepsy and proper anticoagulstion, a small inguinal incision made. Through this incision, the physician will introduce a small narrow tube into the femoral vein, then through this tube a catheter will be introduced directly to the testicular vein, under fluoroscopic control (X ray control).

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. A small amount of special dye, called contrast medium, is injected down the catheter to check the abnormal veins, to provide direct visualization of the veins to map out exactly where the problem is and where to embolize, or block, the vein.

By using coils or sclerosants (medicine injected into blood vessels to make them shrink), an interventional radiologist blocks the abnormal veins, which reduces pressure on the varicocele. By embolizing the vein, blood flow is redirected through other pathways. Essentially blood flow to the incompetent vein is “shut off” internally, accomplishing what the urologist does without surgery.

The catheter with sclerosants or coils will be left in place for up to 10min to ensure the veins block completely, and the catheter is removed.

Is it painful?

No, usually, the intervention is performed under local anesthesia. You will be awake during the procedure and able to tell the radiologist if you become uncomfortable.

How long does it take?

Every patient’s situation is different. Generally, the procedure will be over in about an hour, but you may be in the X-ray department for a couple of hours. In some patients who have different anatomy or only a small varicocoele it may not be possible to catheterise the vein coming from the testis. If this is the case it will not be possible to treat the veins in the scrotum and the procedure will only provide diagnostic information to consider other forms of treatment (open or micro-surgery).

Risks

The complications are reduced by the proper preparation and the continuous surveillance of the patient. Potential complications:

• allergic reactions to administered substances, including renal disfunction

• reactions to anesthetic compounds

• arteriovenous fistulas at the vascular puncture site

• minor bleeding at the vascular puncture site, haematoma

• fever

• headache, migraine

• infection

• gaseous embolism

• a small number of patients the liquid/foam used to close down the vein can irritate the veins around the testicles in the scrotum and this can result in discomfort or pain for a few days. This usually goes away with simple painkillers (paracetamol or ibuprofen). This does not cause any injury to the testicle.

• 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 the procedure may need repeating, or you may be advised to have an operation.

Before procedure

The preoperative assessment will establish if the interventional treatment is the best option for you.

Prior to the intervention, the your doctor must be prevented about any history of allergic reactions. Blood tests are taken including hemoglobin level, coagulation, renal function, and other specific tests.

The patient is admitted the day before the intervention, and he should not eat before the procedure.

Your doctor will tell you if you should not use some drugs before the prcedure.

After procedure

You will be taken back to the recovery area on a trolley and be able to sit up. You will be given pain medication for incisional pain. The nurses will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no untoward effects. They will also look at the skin entry point to make sure there is no bleeding from it. You will generally stay in bed for a few hours, until you have recovered when you will be allowed home.

Since the procedure is minimally invasive, the postprocedural recovery is usually very fast. The majority of patients can leave the hospital the following day. Indications about recovery and postprocedural treatment will be clearly specified to all patients.

While you should continue to walk and undertake light activities you are asked to avoid any vigorous exercise or heavy lifting for at least 5 days to allow the inflammation in the vein to settle down and stop the vein from re-opening. The veins in the scrotum (varicocele) slowly disappear in most patients over the next 8 – 12 weeks, in a minority of patients some small veins remain but symptoms improve in the over 90% of patients.

Important!

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Varicocele embolisation is considered a very safe procedure, designed to prevent you having a larger operation. There are some slight risks involved however they are generally minor and occur infrequently. Catheter-directed Embolization is a minimally invasive procedure wich has a lot of advantages:

• no surgical incision in scrotal area

• as effective as surgery, as measured by improvement in semen analysis and pregnancy rates

• patients can return to normal daily activities immediately; surgery requires several weeks’ recovery and hospital admittance

• the rare patient who has varicoceles on both sides can have them fixed simultaneously through one vein puncture site; surgery on both sides requires two separate open incisions

•no general anesthesia required

• no sutures.

DOCTORS
that perform the procedure

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Yandex.Metrica