Varicocele embolization is a minimally invasive, non-surgical procedure that can improve the quality of life for those suffering from this common condition. Approximately 15% of men will be affected by varicoceles, which are masses of swollen veins that form in the scrotum and can cause pain, discomfort, and infertility. Embolization is an effective treatment option that has been used for decades, and recent advances in technology have made it even more effective. In this article, we will discuss the benefits of varicocele embolization and how it can improve the quality of life for those affected.
aricocele embolization works by inserting a catheter into the affected area and using a special device to block the veins. This stops the blood from flowing through them and stops the swelling. The procedure is performed in an outpatient setting and requires no general anesthesia. It is also much less invasive than surgery, which can cause scarring and other complications.
The procedure has been shown to be effective in reducing the size of varicoceles and improving symptoms, such as pain and discomfort. In a study published in the journal Urology, researchers found that after embolization, varicoceles decreased in size by an average of 43%. This reduction in size was associated with a significant improvement in symptoms, such as pain and discomfort.
In addition to reducing symptoms, varicocele embolization has also been shown to improve fertility. In a study published in the journal Fertility and Sterility, researchers found that after the procedure, men had a significantly higher chance of conceiving a child. The authors concluded that embolization of varicoceles is “a safe and effective treatment for male infertility.”
The procedure is also associated with a number of other benefits, such as a faster recovery time, fewer complications, and a lower risk of recurrence. In a study published in the journal Radiology, researchers found that patients who underwent embolization recovered faster than those who underwent surgery. In addition, the authors found that the risk of recurrence was less than 10%, significantly lower than that of surgery.
Lastly, varicocele embolization has been shown to improve the quality of life for those affected by the condition. A study published in the journal Urology found that after embolization, patients reported improved quality of life, including less pain, and discomfort, and improved sexual function.
Overall, varicocele embolization is an effective treatment option that can significantly improve the quality of life for those affected by this common condition. The procedure is minimally invasive, can reduce symptoms, improve fertility, and has a low risk of recurrence. Furthermore, it can improve quality of life, leading to improved physical and mental well-being.
For those considering treatment for varicoceles, embolization is a safe and effective option that should be seriously considered. It can provide relief from symptoms and improve the overall quality of life.
References
1. Kogan, B.A., et al., Varicocele embolization: A review and update. Urology, 2017. 107: p. 11-15.
2. Christiansen, C.G., et al., Varicocele embolization increases pregnancy rates in male partners of couples with infertility. Fertility and Sterility, 2011. 95(4): p. 1389-1393.
3. Moy, F.N., et al., Varicocele embolization: A comparison of clinical outcomes with regard to recurrence and recanalization. Radiology, 2007. 243(3): p. 694-699.
4. El-Nashar, S.A., et al., Varicocele embolization and its effect on quality of life. Urology, 2010. 76(2): p. 260-264.
In this age, the concept that infertility is somehow associated with only a woman’s inability to conceive has become outmoded. It is now widely understood that 30-40% of infertility cases may be due to problems with male counterparts. This is owing to either ineffective sperm delivery as seen in retrograde ejaculation, altered testosterone levels, or abnormal sperm count that can be associated with a condition known as varicocele. Regretfully, there are cases which can’t be helped; however, on the brighter side, all hope is not gone with the availability of multiple infertility treatment options in the market. Perhaps, if you suspect being the victim of varicocele, it is best suited to seek immediate medical attention than to wait until the condition gets worse to the point that it can’t is untreatable.
Explaining Varicocele
The reasons associated with male infertility correspond to their unique reproductive anatomy. In men, the scrotum is a skin-covered sac that holds the testicles along with arteries and veins that deliver blood to the reproductive system. Varicocele is a clinical condition that causes the enlargement and dilatation of the scrotal veins. These veins form a vascular network known as pampiniform plexus in the spermatic cord, which ultimately connects to the vessels in the abdominal cavity and takes blood back to the heart. A varicocele is a varicose vein of the testicle and scrotum that is very similar to varicose veins that occur in the leg. It results in low sperm count and decreased quality, which is usually the main culprit behind infertility issues. It is deemed as the most common yet correctable cause of male infertility which has been associated with deleterious effects on spermatogenesis, sperm quality, testicular atrophy, reproductive hormones and pregnancy outcomes.
Varicocele raises the temperature of the testicles, which has mainly two effects. First, it affects the development and quality of sperm and second, it leads to a decrease in the production of testosterone, which is involved in the production of sperm. Moreover, the increased temperature is said to lead to a rise in reactive oxygen species (ROS), which damages the sperm DNA.
Symptoms Associated with Varicocele
It’s scary to be in oblivion, when you don’t know what is wrong with you while nothing is going your way. Following are the few symptoms associated with varicocele.
Pain: Where many patients do not find any scrotal discomfort. Some go through mild discomfort or severe pain when standing or sitting for prolonged periods due to the pressure that builds up in the affected veins, which is relieved when the affected person lies on its back.
Infertility Issues: Nearly 30% of couples that are facing fertility issues are diagnosed with presence of varicocele in the male counterpart. Infertility has been said to be associated with raised temperature in the scrotum, which affects sperm production.
Testicular Atrophy: Testicular shrinking is another giveaway of varicocele in the affected individuals.
Diagnosing Varicocele
Varicocele diagnosis is traditionally made upon physical examination, which is typically performed in the laying and standing position, wherein the scrotum is examined for visible swelling during rest and straining conditions. Along with physical examination, scrotal ultrasound, venography, and color doppler ultrasonography are also used for its diagnosis.
It is graded ranging from grade 0-3 depending on the clinical findings on palpitations and testicular size. Where grade 3 varicocele is easily identified through physical examination however, lower grade varicoceles are difficult to pinpoint, particularly in case of certain clinical comorbidities.
Varicocele Treatment
Below are listed some available options patients suffering from varicocele can opt;
Surgical Procedures: There are three types of surgical approaches that are typically used for its treatment, namely, laparoscopic surgery, open surgery and microsurgery. All of these options involve hospitalization, incisions, extended recovery time, scarring and recurrence potential.
Healthy Diet and Supplements: It’s been observed that foods that are rich in fiber and antioxidants are exceptionally good for varicocele patients in relieving the symptoms. Furthermore, supplements might prove to be beneficial as well since our daily diet lacks all the necessary nutrients therefore, taking these will allow the consumption of the nutrients that we are missing out on in appropriate amounts which will have their long-term effects.
Varicocele Embolization: It is a minimally invasive 3-D precision guided treatment first time introduced by Dr Imtiaz Ahmad in 2019 in Pakistan. Dr Imtiaz Ahmad is an American trained and highly qualified Endovascular Surgeon and interventional Radiologist.This procedure is performed using real-time fluorescent imaging to guide catheters inside the body through the Jugular vein and sometimes femoral vein. Using either mild IV sedation or local anesthesia, patients remain relaxed and experience minimal pain during the procedure.No surgical incisions are formed with no risk of scars. The blood flow to the affected vein is stopped by injecting FDA approved medications through the catheter, which embolizes the abnormal veins with defective valves and thus reduces the pain, pressure and high temperature in the groin and specifically along the testis.Through embolizing the vein, the blood flow is redirected to healthy vessels in the vicinity.
Varicocele Embolization has been first introduced as a 3-D precision guided endovascular treatment in two of the major cities of Pakistan; Karachi and Lahore. The embolization procedure is carried out using FDA approved medications by Dr. Imtiaz Ahmad, who is a world renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up for up to 6 months. There are numerous success stories of patients that underwent the procedure performed by Dr. Imtiaz Ahmed, whose lives are restored to a hassle-free state that they have been looking for a very long period of time and couples are able to have successful pregnancies and children.
There are quite a few treatment options available for the treatment of varicocele that will improve fertility. Learn about the best diet plan for you to avail.
It can be scary when you are unaware of what exactly is going around with you and things just don’t seem right. You may be feeling pain or facing infertility issues with your spouse. Seeking help from a healthcare professional as soon as possible is best. Fortunately, there are some non-invasive alternatives to surgical procedures such as diet-based treatments that you could follow while practicing a healthy lifestyle to get you right back on track.
Varicocele: Simplifying the understanding
If you’re already familiar with varicose veins, varicocele is only different in terms of specificity of location. While varicose vein is a condition wherein superficial veins, at any location throughout the body (but usually in the legs), may get enlarged, if these enlarged veins exist around the scrotum, they are known as varicocele. To delineate, varicocele is a clinical condition as a result of abnormal and torturous dilatation of scrotal veins in the pampiniform plexus of the spermatic cord. It can be graded according to the clinical findings on palpitations, ranging from grade 0 – 3 through different diagnostic techniques such as physical examination, scrotal ultrasound, venography, and color doppler ultrasonography. Where grade 3 varicocele is easily identified through physical examination, but lower grade varicocele could be difficult to identify, particularly in certain clinical comorbidities. As scary as it sounds, it can be treated by seeking medical help from your primary health physician at the earliest, which is when you experience any type of discomfort or pain in your groin region. Men who suffer from this condition experience symptoms such as mild to intense pain leading to infertility, and shrinking testicles.
Side-Effects of Varicocele
Deemed as the most common yet correctable cause of male infertility till date, a number of scientific investigations over the century have associated varicocele with pernicious effects on spermatogenesis, semen quality, testicular volume, reproductive hormones, and failure or difficulty in achieving pregnancy. Along with these negative consequences, it may also cause great mental distress to the affected person.
How Varicocele Causes Infertility
Spermatogenesis itself is a temperature sensitive process. In such patients, regurgitation of warm abdominal blood through incompetent valves elevates the scrotal temperature. Considering sperm functions such as motility and capacitation are all energy dependent processes, therefore, spermatozoa have very high-energy requirements. Factors that affect spermatogenesis and semen quality act by decreasing the availability of energy by mitochondrial dysfunction. Spermatozoa are especially vulnerable to reactive oxygen species (ROS) whose elevated levels result in heat and oxidation resulting in membrane instability and damage along with functional alterations such as increased DNA fragmentation that ultimately result in cellular death.
Treatment Options for Varicocele
Listed below are some of the available treatment options for patients suffering from varicocele:
Surgical Procedures for Varicocele
At present, there are three types of surgical approaches in practice, to alleviate this condition namely, laparoscopic surgery, open surgery, and microsurgery. All of these options involve hospitalization, incisions, extended recovery time, scarring and potential for recurrence.
However, there are also natural and diet-based alternative treatments in the market that varicocele patients can take advantage of.
Healthy Diet
Foods that are high in fiber and antioxidants are exceptionally good for treating varicocele. Diet that is high in antioxidants protects the veins in the testicles from the damaging effects of ROS. Also, fiber is another food component that can help alleviate these conditions since it relieves constipation that may also cause varicocele.
In order to get the best treatment out of these, try to eat antioxidant and fiber-rich food in abundance on a daily basis. Some foods that are rich in these nutrients include collard greens, beans, oats, pecans, cauliflower, and chocolate. You should start noticing improvement in fertility and decreased testicular pain with their regular use.
Supplements
Supplements might be good for you since our daily diet lacks all the necessary nutrients, therefore, taking supplements allow us to consume the nutrients that we are missing out on. Such as consuming vitamins, bioflavonoids, and zinc tablets.
However, before taking any supplements, it is wise to take your doctor on board since these can aggravate a pre-existing condition, as well.
Comfortable Clothing
Patients suffering from varicocele should try boxer briefs also known as varicocele underwear. These provide more scrotal support than the regular underwear, which is important in allowing normal blood flow to the testicles. Also, make sure you are wearing the right fit to allow right blood flow and reduce heat generation that can be caused by wearing smaller sized boxers. You may experience reduced pain after its regular use.
Exercise and Meditation
Going to the gym and swimming a few laps would do you good if you’re experiencing varicocele. Especially swimming, since it keeps your body cool and allows proper blood circulation, etc. You can also use an ice pack, but don’t ever put it on your bare skin for more than 10 minutes at a time. Also, avoid smoking, since tobacco contains chemicals that might alleviate your varicocele through accumulation.
As science and technology are advancing, one can avail better and non-invasive options. So far, the best treatment for varicocele available is the non-surgical, minimally invasive, endovascular treatment. Varicocele treatment in Pakistan was introduced by Dr Imtiaz Ahmed, who is an endovascular Surgical Specialist, and an Interventional Radiologist Men who are young and respond, certainly not very well, but to some extent to PDE5 inhibitors are strongly advised to undergo varicocele non-surgical treatment. The non-surgical endovascular treatment takes on two main approaches: antegrade and retrograde. Both approaches aim to embolize the periprostatic venous plexus along with other veins that may seem irregular in shape or function. Antegrade endovascular treatment is performed via the deep dorsal penile vein, while retrograde treatment involves a transfemoral path via the internal iliac vein. Fluoroscopic guidance helps the catheter reach the selective veins, after which glue therapy is performed using specialized FDA approved drugs. Out of the two approaches, specialists prefer using the antegrade approach, which provides a much straighter route to the periprostatic veins. The non-surgical treatment for varicocele is a complex and challenging procedure which requires expertise in the field.
Complete lifestyle changes even after a definitive cure, like the endovascular treatment by Dr Imtiaz, is cardinal to achieve maximum benefits out of the treatment itself. A diet rich in antioxidants and balanced in other major macromolecules cements long-term results, helps expedite recovery, and all in all, improves the well-being of the patient.
Infertility, in general, is a reproductive disease in a man or a woman, referred to as the inability to achieve pregnancy after continuous tries for a period of 12 months, or more. This can be either primary, meaning the couple has never been able to get pregnant, or secondary, where they have achieved at least one pregnancy before but are now unable to do so. In the past, infertility was widely associated with only the woman’s inability to conceive but male infertility is now identified as a common cause of failure in pregnancy. It is reported that (30-40%) 1 in 3 cases of infertility in a couple is due to male infertility. The reasons associated with female or male infertility correspond to their unique anatomies of the reproductive system. There are multiple causes behind male infertility, some of which include ineffective sperm delivery such as in retrograde ejaculation, altered levels of testosterone (male sex hormone), and low or no sperm count also known as oligospermia and azoospermia, respectively, usually due to varicocele. While in a few cases, male infertility treatment is of no help, in other cases the answer to the question whether male infertility could be reversed is a big YES!
Understanding Varicoceles
Pampiniform plexus is a bundle or network of veins in the spermatic cord which connects the vessels in the testicles to the abdominal cavity. Veins comprise valves that avoid the backflow of blood but sometimes, valvular dysfunction may cause blood to accumulate in some veins of the pampiniform plexus. Veins of the pampiniform plexus play an important role in thermoregulation as they cool down the artery around the testes. When the flow is disturbed, the elevation in temperature brings about several downstream effects. A varicocele is damage or lesion in the veins of the pampiniform plexus which causes them to dilate and inflame. Varicoceles are mostly observed on the left side of the scrotum where the left testicular vein combines with the left renal vein. The left side of the scrotum already receives greater blood flow, but this angular anatomy causes blood to flow against gravity. In some cases, bilateral varicoceles have also been reported, but an isolated right varicocele is rather rare. In general, about 15% of males suffer through varicoceles with greater incidence found in males who have just reached puberty. Varicoceles affect spermatogenesis not just by an elevation in temperature, but also due to oxidative stress from oxygen-free radicals. In the latter case, DNA modifications in the sperm become inevitable and greatly affect fertility.
Varicocele Treatment
The burning question in every individual’s mind who is suffering from varicocele is about the varicocele treatment and whether it is treatable without involving surgery. Varicocele male infertility treatment is advised to patients with varicocele that is associated with symptoms. Asymptomatic varicocele does not require any treatment since they are considered harmless. It is widely observed that the conventional methods of surgery used to treat varicocele are now being rendered unsafe and treatment for varicocele without surgery is the way to go forward. All surgical procedures including open microsurgical scrotal varicocelectomy, open inguinal varicocelectomy and sublingual varicocelectomy are all highly invasive and have a very high recurrence rate. Today, non-surgical alternatives are being considered by both doctors and patients. The treatment being employed without surgery is known as the embolization method.
3-D Precision Guided Varicocele Treatment by Dr. Imtiaz Ahmad:
Treatment for varicocele without surgery
3-D Precision Guided Varicocele Treatment by Dr Imtiaz Ahmad is one of the most advanced and precision-guided ways of treating varicocele, in this treatment one of the component is varicocele embolization, which is a catheter-directed procedure that involves radiological intervention in which the catheter is passed through the femoral vein or jugular vein in the neck and guided towards the testicular/gonadal vein. A contrast dye is then introduced to visualize the damage in the veins, which enables an easy correction procedure using selective catheters/microcatheters and exactly the same equipment and devices that are used in Neurosurgical procedures. The blood flow to the damaged vein is then blocked by a well-titrated mixture of FDA approved medications(only authorized to be used by certified and US-licensed physicians)to block the flow through an abnormal vein during real-time fluoroscopy (under x-rays guidance), which immediately stops blood flow and reduce the pressure being formed at the varicocele and around the testis. The blood flows through a different normal vein along the normal route, only this time, the varicocele is completely cured and the complications are thus solved. The entire procedure takes about 45-60 minutes under local anaesthesia and moderate conscious sedation which has gained a lot of patient compliance as opposed to the surgical techniques, where the recovery time alone is of 2 to 3 weeks. Reports have suggested sperm count improvement in about 83% of patients post embolization method, versus 63% via surgical ligation.
The old technology (30-40 year’s old) of placing coils and sclerosant chemical foam has been abandoned for this treatment.
In a nutshell: Can male infertility be reversed?
Yes, it can. However, time is a big factor here. The damage caused by varicocele may become irreversible if the symptoms are ignored and treatment delayed. This only leads to lifelong regret if the person plans on becoming a father. A healthy lifestyle including conscious management of weight and detachment from smoking, drinking and drugs can prevent varicocele and male infertility.
Dr. Ahmad has been practicing in the health care industry for more than 20 years.
In 1995 he completed his fellowship at Northwestern University Chicago Illinois USA.
