• Reference Number: HEY1243/2021
• Departments: Radiology
• Last Updated: 30 June 2021

Introduction

This leaflet has been produced to tell you about having Varicocele Embolisation. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a varicocele embolisation?

A varicocele is an abnormality of the veins that take the blood away from the testis.

The valves in the veins do not work properly and so the veins become bigger and more obvious, rather like varicose veins in the leg. Embolisation is an X-ray guided treatment, which blocks the enlarged vein from the testis typically using a coil and allows the veins to shrink.

Why do I need an embolisation?

A varicocele can cause discomfort in the scrotum, which is often worse when standing, exercising or cycling. They are sometimes diagnosed during the investigation of infertility and treatment may help your sperm count.  There are a number of ways to treat varicoceles including open groin surgery, laparoscopic surgery and minimally invasive interventional radiology.

Interventional radiology uses X-rays to guide a small tube to the vein to block it with only a 3 – 4mm incision in the groin.  It is performed as a day case procedure.

The decision to perform this procedure has been discussed with your referring surgeon and the interventional radiology consultant who feel this is the best option. However, you will also have the opportunity for your opinion to be considered and if, after discussion with your doctors, you no longer want the procedure, you can decide against it.

Can there be any complications or risks?

Varicocele embolisation is a very a safe procedure, but as with any medical procedure there are some complications or risks that can arise.  There may occasionally be a small bruise called a haematoma around the site where the needle has been inserted into the vein.  This will go away in a week or two. A few patients may experience mild discomfort in the loin or scrotum afterwards which rarely lasts more than a few days.

There is a small risk that a coil, used to occlude the vein, could migrate to your lungs.  If this happens and it cannot be retrieved it is very unlikely to cause any problems other than a cough and mild chest pain for a few days.

Rarely, it may not be possible to obtain a satisfactory position for embolisation, in which case a surgical operation may be offered.

Unfortunately, there is a possibility that the varicocele may come back again. This may also happen after any surgical treatment. If this happens, then the procedure may be repeated, or you may be advised to have an operation.

How do I prepare for the embolisation?

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

Varicocele is usually carried out as a day case procedure under local anaesthetic.  You may eat and drink prior to your procedure.

Prior to the appointment for your procedure you will be contacted by the nursing team to discuss your medical history, any allergies you may suffer from, and any current medications that you take.  You will be advised then if you need to omit any medication, in particular medication that thins your blood.

What will happen?

You will be asked to attend the Radiology Day Unit on the second floor at Hull Royal Infirmary and the procedure will be performed in the radiology theatre.  This is similar to an operating theatre where special X-ray equipment has been installed.

You will have preliminary checks made by a radiology nurse such as blood pressure reading and arrangements for who to contact to take you home. You will meet the Interventional radiologist who is a doctor with special expertise in reading X-rays and using these to guide catheters and wires to aid treatment.  The radiologist will explain the procedure and ask you to sign a consent form.  Please feel free to ask any questions that you may have and remember that, even at this stage, you may decide against going ahead with the procedure if you so wish.

You will be asked to change into a hospital gown. You will lie on your back on the X-ray table and you will be attached to a monitor to check your blood pressure and oxygen levels.

The procedure is performed under sterile conditions and the interventional radiologist and radiology nurse will wear sterile gowns and gloves. The skin near the point of insertion in the groin will be swabbed with antiseptic and you will be covered with sterile drapes. The skin and deeper tissues over the vein will be numbed with local anaesthetic, and then a fine tube (catheter) will be inserted and guided, using the X-ray equipment, into position down the vein (testicular vein), which takes blood away from the testis. The interventional radiologist will block this vein usually by inserting small metal coils, which look like springs and will remain in the abnormal vein. The radiologist will inject small amounts of dye (contrast agent) to check the position of the catheter and that the abnormal veins are blocked satisfactorily. Once they are blocked, the catheter will be removed. The interventional radiologist will press firmly on the skin entry point for a few minutes to prevent any bleeding.

The procedure should not be painful.  When the local anaesthetic is injected, it will sting for a short while but should soon wear off. You may feel a warm sensation for a few seconds when the X-ray dye (contrast) is injected, and you may feel like you are passing urine. The procedure usually takes up to an hour.

What happens afterwards?

You will be transferred to a trolley in the Radiology Day Unit to rest.  The nurses will check your pulse, blood pressure and the puncture site in your groin at regular intervals. They will advise when you can sit up and offer you a drink and something to eat. You will be allowed to go home 2-3 hours after completion of the procedure.

You will need to be escorted home and have a responsible adult stay with you overnight.  You should take things easy for the rest of the day with no strenuous exercise or sexual activity. You should be able to resume normal activities the following day.  Please discuss with your doctor when it is advisable to return to work. The nurse who discharges you will give you a list of do’s and don’ts as a reminder.

You will have a follow up appointment with your referring surgeon.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Interventional Radiology Department (01482) 675667

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.