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Varicocele surgery or embolization: Which is better?

Darby Cassidy¹, Keith Jarvi, Ethan Grober

¹University Hospital of Northern British Columbia, Prince George, BC;

Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada

|October 25, 2012

Summary

Varicocele embolization has a high failure rate for bilateral cases, especially on the right side. Microsurgery is recommended for bilateral varicoceles, while unilateral left-sided varicoceles can be treated with either embolization or surgery.

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Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

Microscopic Varicocelectomy under Local Anesthesia as the Treatment of Varicocele

Published on: October 25, 2024

Area of Science:

Urology
Interventional Radiology
Reproductive Medicine

Background:

Varicocele is a leading correctable cause of male infertility.
Surgical varicocele repair has a low failure rate (<5%).
Selective catheterization and embolization of the gonadal vein is an alternative treatment.

Purpose of the Study:

To evaluate the outcomes of varicocele embolization.
To compare the efficacy of embolization for unilateral and bilateral varicoceles.

Main Methods:

Retrospective review of 158 patients undergoing varicocele embolization (2004-2008).
Analysis of attempted bilateral, unilateral left-sided, and unilateral right-sided embolizations.
Assessment of technical failure rates for each approach.

Main Results:

Bilateral embolization had a 19.3% failure rate, primarily due to right gonadal vein occlusion failure.
Unilateral left-sided embolization had a 4.4% failure rate.
Unilateral right-sided embolization had a 0% failure rate in 2 attempts.

Conclusions:

Bilateral varicoceles are best treated with microsurgery due to high embolization failure rates.
Embolization and surgery have similar failure rates for unilateral left-sided varicoceles.
Embolization offers patient advantages for unilateral left-sided varicoceles.