Venous Embolisation for Symptomatic Varicocele

1) Understanding the condition

A varicocele is a network of enlarged veins in the scrotum (similar to varicose veins). It often feels like a “bag of worms” and is most commonly on the left side.

Many men have no symptoms. When symptoms occur, they often include:

• • A dull, aching or dragging discomfort in the scrotum
  • A feeling of heaviness, often worse with standing, exercise, or later in the day
  • Occasionally, visible or lumpy enlarged veins

In adolescents, a varicocele can sometimes be associated with reduced growth of the affected testicle, and treatment may be recommended in selected cases.

2) When is treatment considered?

Many varicoceles do not require treatment. Treatment is considered when there are:

Persistent symptoms

• • Ongoing discomfort or heaviness that affects daily life or sport, especially if not improving with simple measures.

Other situations

• • A varicocele associated with reduced testicular size (particularly in adolescents)
  • Male fertility issues. This decision is made collaboratively with your urologist and in the context of relevant semen testing results.

3) Treatment options

There isn’t one “best” treatment for everyone. Options include:

Conservative management
Supportive underwear, activity modification, and simple pain relief.

Surgical varicocelectomy
A urological operation to interrupt the abnormal veins.

Varicocele embolisation
A minimally invasive, image-guided procedure performed by an interventional radiologist. It treats the same problem of abnormal venous drainage without a surgical incision.

4) What is varicocele embolisation?

Varicocele embolisation uses a catheter (thin plastic tube) placed into the malfunctioning testicular vein to deliver tiny coils and liquid sclerosing agent or medical glue to close off the vein draining the testicle. This diverts blood flow to healthier veins and reduces pressure in the varicocele.

It is a non-surgical treatment performed by an interventional radiologist and is typically a day procedure.

5) Planning and tests

Your assessment may include:

• Clinical examination often standing and lying
• Scrotal ultrasound to confirm the diagnosis and assess reflux

6) The embolisation procedure

Varicocele embolisation is performed in a radiology x‑ray suite. It generally takes around 60–90 minutes and is usually done with local anaesthetic and sometimes with sedation.

In the public hospital setting, you’ll be provided medical sedation and local anaesthetic at the access site (base of the neck). Anaesthetic support is provided in the private hospital setting and anaesthetic options can be individualised in discussion with the anaesthetist.

A catheter is then placed into the vein and guided under x‑ray to the abnormal testicular veins. A “venogram” contrast x‑ray map of the veins is performed to confirm the abnormal drainage pattern. Coils and/or medication are placed to close the abnormal veins. The coils are soft, inert and designed to stay in place long‑term.

After the procedure you’ll rest for a couple of hours, then go home the same day in most cases.

7) Preparing for your procedure

On the day of your procedure, you need to arrive fasted (no food or drink). The hospital will provide specific instructions.

Blood tests may be done before the procedure to check your kidney function and blood clotting.

If you take blood thinners (anticoagulants), these may need temporary adjustment. Please confirm this with the Hospital and Doctor’s secretary before your admission.

8) Recovery (the first days to weeks)

Most patients:

• Rest for the remainder of the day
• Resume normal non‑strenuous activities the next day
• Return to work/study within a couple of days

Mild aching in the groin, lower back, or scrotum can occur for days to occasionally a couple of weeks and is usually managed with simple pain relief.

Many men notice symptom improvement within weeks, with continued improvement over a few months.

9) Benefits of embolisation

Varicocele embolisation is minimally invasive and typically offers:

• No surgical incision
• Day procedure with quick recovery
• Low infection risk
• The ability to treat venous anatomy under direct x‑ray mapping venography during the procedure

10) Risks and side-effects

Varicocele embolisation is overall very safe, but like any medical procedure, complications can occur.

Common / minor:

• Bruising haematoma at the puncture site
• Temporary groin/scrotal discomfort

Uncommon:

• Technical difficulty preventing completion of embolisation (you may then be offered surgery)
• Recurrence of varicocele over time. This can occur after either embolisation or surgery; repeat treatment is sometimes possible

Rare:

• Migration of a coil (very uncommon). If it occurs it is usually manageable and rarely causes significant problems
• Contrast reaction, vein injury, or infection (rare)

11) What the studies show

Clinical experience and published patient information resources indicate that varicocele embolisation is a well-established, minimally invasive treatment for symptomatic varicocele, with outcomes that are broadly comparable to surgical repair in appropriately selected patients.^1,2,3

• Technical success / effectiveness: Percutaneous embolisation has been reported to successfully treat varicoceles in a high proportion of cases, with success rates around ~90% described in the literature.¹
• Symptom relief: Embolisation is associated with improvement or resolution of varicocele-related pain and discomfort in most patients, often noted within a few weeks to months after treatment. ^1,2
• Recurrence or persistence: Recurrence can occur after either embolisation or surgery. Both approaches are used in clinical practice. ^1,3
• Complications: Overall complication rates for embolisation and surgery are reported to be similar, with complications generally uncommon and most being minor and self-limiting (such as bruising or temporary discomfort). ^1,2

Overall, embolisation is recognised as an effective, minimally invasive alternative to surgery, with advantages including treatment under local anaesthetic, rapid recovery, and the ability to treat complex or recurrent venous anatomy using image guidance. ^1,3

12) Frequently asked questions

Will embolisation affect testosterone?
A varicocele is a venous drainage problem. Embolisation targets abnormal veins and does not involve operating on the testicle itself. If hormone issues are a concern, your urologist may organise blood tests as part of a fertility evaluation.

When can I exercise or have sex again?
Light activities such as walking are usually fine the next day. Most patients are advised to avoid strenuous exercise, heavy lifting, cycling, or running for about 5–7 days to allow the puncture site and treated veins to settle. Sexual activity can usually be resumed after about 1-2 weeks, once any groin or scrotal discomfort has resolved. Advice may be adjusted depending on your access site, symptoms, and recovery.

Can the varicocele come back?
Yes, recurrence can occur after embolisation or surgery. If symptoms recur, repeat embolisation or surgery may be options.

Can this be used to treat male infertility?
Sometimes a varicocele can be associated with reduced fertility and you may be referred for varicocele embolisation in this context. Fertility-related decision-making is best guided by your urologist and fertility team.

Is embolisation “better” than surgery?
They are different approaches to treating the same problem. Many men choose embolisation because it is minimally invasive and avoids a surgical incision; others may prefer surgery based on urologist recommendation, anatomy, and goals. The best option depends on your situation and should be decided with your urologist and interventional radiologist.

13) References

1. 1. Leslie SW, Sajjad H, Siref LE. Varicocele. StatPearls. Treasure Island FL: StatPearls Publishing; updated regularly. Available at: ncbi.nlm.nih.gov/books/NBK448113/
   2. Mayo Clinic. Varicocele: diagnosis and treatment. Mayo Foundation for Medical Education and Research. Available at: mayoclinic.org/diseases-conditions/varicocele/diagnosis-treatment/drc-20378772
   3. Healthdirect Australia. Varicocele. Australian Government Department of Health. Available at: healthdirect.gov.au/varicocele
   4. Society of Interventional Radiology of Australasia. Varicocele embolisation – patient information.

Prepared for patients of Dr James Hillhouse, Interventional Radiologist.

This information is general and should be discussed with your treating clinicians.