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. This makes them less obvious and causes the varicocele to disappear without an operation.
Who has made the decision?
The consultant in charge of your care and the radiologist carrying out the varicocele embolisation will have discussed the situation. They feel that this is the best treatment option. 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 then 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. They need to look at these images while carrying out the procedure.
Where will the procedure take place?
This will take place in the Imaging Department, Gate 19, as described in your appointment letter.
What happens before the procedure?
You will need to have a blood test a few days before the procedure to check your kidney function, that you are not at increased risk of bleeding and that it will be safe to proceed. This may be arranged to take place at your GP surgery.
You can continue taking your normal medication. If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging Department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.
You will also need to make sure that you have somebody to bring and collect you from the hospital, as you will not be able to drive immediately after the procedure. You must also ensure that there is a responsible person to be with you after and during the first night following the procedure in case you have any difficulties.
On the day of the procedure
- You should not eat anything from 4 hours before your procedure but you may continue to drink water.
- You will arrive at the Imaging Department, Gate 19, and be accompanied into our day case area.
- You may take your normal medication unless instructed otherwise.
- Please inform us if you have any allergies.
- A radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form.
- You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
- Once all the checks have been performed and consent signed, you will be taken to the angiography suite on the trolley. There will be a nurse, radiographer and a radiologist with you throughout the procedure.
During the procedure
- You will need to lie on your back on an x-ray table for the duration of the procedure.
- The skin near the neck or groin will be cleaned with an antiseptic solution and covered with sterile drapes.
- Using an ultrasound machine, the radiologist will then inject local anaesthetic into the skin and deeper tissues over the neck or groin. This will briefly sting and then go numb. Most people will feel a pushing sensation.
- A catheter (thin tube) is positioned into the testicular vein with the help of the x-ray machine. Small, metal coils are then used to block off the abnormal testicular vein.
- Once the procedure is complete, the radiologist will remove the catheter and press gently on the entry site for a few minutes to prevent bleeding.
- The whole procedure will take around 40-60 minutes although treating both sides will take longer.
What to expect after the procedure
- You will be taken back to the day case unit, so that nursing staff may monitor you closely. They will let you know when you can eat, drink and mobilise.
- If you are feeling okay and your checks are normal, you may go home.
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 around the site where the needle has been inserted. A small amount of bruising is quite normal, but if this becomes a large bruise then there is the risk of it becoming infected. This would then require treatment with antibiotics.
- Some patients experience mild discomfort in the left flank for a day or two, needing no more than simple painkillers, if anything.
- 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 performed with no significant side effects at all.
What about the metal coils?
The coils are made of platinum and look a bit like light bulb filaments. They will show up whenever you have an x-ray or CT scan but will not activate airport metal detectors. As they do not contain iron, it is safe should you ever need a Magnetic Resonance Scan (MRI).
Finally, we hope this information is helpful. If you have any questions, either before or after the procedure, the staff in the Imaging Department will be happy to answer them. The telephone number for the Imaging Department can be found on your appointment letter.
Reference: British Society of Interventional Radiology (2011) “Varicocele embolisation Patient information” www.bsir.org Accessed on 15/05/2020
How to contact us:
If you have any queries please contact the number on your appointment letter.
If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
© North Bristol NHS Trust. This edition published April 2021. Review due April 2023. NBT002077