Painful Varicoceles

Painful Varicoceles
Paul Jasan Dorio Radiologist Cincinnati, OH

I am the Director of Interventional Radiology of Paradigm Radiology, the Cincinnati section of Radiology Partners/Columbus Radiology Corporation. In Columbus and Cincinnati, we strive to consistently achieve the highest quality radiology and deliver the best patient care.

Did you know that left testicular pain can be due to something called a varicocele?

A varicocele is a tangle of enlarged veins that can cause local pain and contribute to infertility. There is also a school of thought that the increased heat caused by varicoceles may increase the risk of prostate cancer. Varicoceles are also associated with testicular atrophy over the long term.

These reasons are why I agree that varicoceles should be treated. 

A varicocele is described as feeling like a "bag of worms," which may not be a pleasant-sounding analogy, but it creates a pretty clear mental picture.

Men, or the doctor, typically identify the varicocele on the left and between the ages of 15-45. Ultrasound is usually requested for confirmation. While there is a grading system, the important thing is that varicoceles that cause symptoms and can be felt or seen at physical examination are the best candidates for successful treatment.

If a varicocele is new and right-sided, however, please contact your doctor for further evaluation because right-sided varicoceles can be associated with kidney cancers. These right-sided varicoceles will typically occur in men over the age of 50.

Treatment

Varicoceles can best be treated either by surgery or embolization.

At surgery, a nick is made in the scrotum, the veins are clipped, and the nick is then sewed shut. There is a recovery time that varies from a few days to a few weeks. Post-procedure pain varies but can be expected. Risks primarily include bleeding with rare loss of the testicle. Recurrence is 10-30%.

At embolization, which I offer, a small catheter is threaded through the neck or groin vein and directed to the varicocele. Small particles, coils, glue or foam are then used to block off the veins so blood does not reflux into the scrotum. Recovery takes a mere hour and you go home without any incision to heal and without any scrotal pain from surgery. Recurrence rate is 10-30%.

With both treatment methods, the varicocele shrinks and pain is relieved. Heat caused by increased blood flow diminishes, which decreases any further testicle shrinking and lowers the risk of elevated testosterone levels that may contribute to prostate cancer risk. 

Of course you can visit a surgeon, but then again why wouldn't you want to walk home without any pain or take valuable time out of your week to recover when you can undergo a 1 hour embolization procedure and be back up and doing your thing that very day? Interventional radiology is the way to go.

References

Varicoceles

http://www.drpauldorio.com/varicocele-infertility/

SIR: Varicocele Embolization Reduces Pain and Infertility

https://www.medpagetoday.com/meetingcoverage/sir/8781

Varicocele embolization

https://www.radiologyinfo.org/en/info.cfm?pg=varicocele

Paul Jasan Dorio is the Director of Interventional Radiology of Paradigm Radiology, the Cincinnati section of Radiology Partners/Columbus Radiology Corporation. In Columbus and Cincinnati, his practice strives to consistently achieve the highest quality radiology and deliver the best patient care.