Varicocele Treatment Without Surgery

Dr. Virender Sheorain (USA Return)
Chief Senior Consultant & Vascular Specialist
Medanta-The Medicity Hospital, Gurgaon, India

I am Dr. Sheorain, Senior Consultant and Vascular Specialist at Medanta-The Medicity hospital, Gurgaon, India. I am writing this blog merely for the purpose of creating awareness among general public and especially among those suffering from VARICOCELE.

I routinely get telephonic consultation calls from across the country regarding varicocele problem. Over so many years, what I have realised is that many patients in our country still feel very shy to disclose their problems affecting private parts. Actually many patients don’t even understand the basic problem behind varicocele disease. Many patients encounter difficulty in correctly speaking or pronouncing the not so simple name “Varicocele” and hence shy to talk about it as well.

Varicocele is actually unheard of by majority during their entire lifetime and when someone gets diagnosed with varicocele, it is nothing less than a shock for him & his family. Once he comes to know that he has a disease called Varicocele, the big question that arises in the mind of the patient is what shall he do next ?

Every patient tries to search for the best available option for treating Varicocele. It is natural for everyone to first look for any possibility of treating his disease with only medicines and to avoid surgery. Nobody will love to undergo unnecessary surgery and to have a Cut or Scar and that too near his private parts.

No one will for sure like have an open surgery with a permanent scar/ cut mark on his skin that too near his private area (Figure 1). Unfortunately there are no definitive medicines that can reverse or treat varicocele including Homeopathy or Ayurveda. However, I have seen many patients being fooled by so called experts of alternative medicine and are given false hope of getting treated with fake medicines.

Let us try to understand what is varicocele actually. It is nothing but a disease that affects the private part in males called SCROTUM. Scrotum is nothing but a Sac that hangs in between the thighs in male (Figure 2). Inside the scrotum sac are present testis and around the testis are many small veins. This small veins sometimes increase in size due to many underlying reasons ( this can be explained in details during OPD consult ).

This large and dilated veins inside scrotum sac causing heaviness, pain and felt by patients or sometimes easily felt by fingers or seen by naked eyes is called as “varicocele” (Figure 3).

The most common presenting complaint is dull aching pain and heaviness in affected or both the scrotum/testicles. However symptoms may vary according to the age and profession of an individual. A teenager usually comes with a complain of sudden feeling of pain in his scrotum after some work, running, high note singing, gym, squash, exercise ,long standing or long travel. The are few patients who are totally asymptomatic but are diagnosed to have varicocele on clinical or ultrasound work up for military recruitment or infertility (unable to become parent). In an era of social media and Internet, most of my patients call me or come to me with a self made diagnosis of VARICOCELE on their own. However, many patients are diagnosed by General Physicians & Surgeons and then are referred to higher centre or specialists for further treatment.

Coming to Treatment part, it depends on many factors and the most important factor is correct Ultrasound Report. If an ultrasound is not performed by a specialist who routinely perform Doppler for varicocele, the findings can be misleading and thus the treatment offered can be completely wrong. I do my own ultrasound before making any decision. The success of varicocele procedure (Embolization) or Open Surgery depends on clinical findings & more so on the ultrasound findings. On Ultrasound & Colour Doppler (Figure 4 & 5) , Varicocele disease is graded depending on the severity of problem from Grade 1 to Grade 5. The details about grade and the benefit of the treatment offered can be discussed in detail during your OPD consultation.

Main debate or dilemma lies between whether one should go for Open Surgery vs Non surgical procedure Embolization:

I get many calls from patients having varicocele asking me a very simple but not so easy question whether SURGERY is better or Embolization?

This is how I see to it and explain my patients. “The only constant in life is change”. We all face changes every day in our life. Initially we all have some hesitation but ultimately we adjust and accept any change which is good for us. Similarly, whenever a new treatment method comes after thorough research, it has many advantages and it is meant to overcome the shortcomings of existing & old traditional surgical method. The problem lies not with the new treatment method but on the part of traditionally trained surgeons who fail to accept this new change in treatment modality and its advantages to the patients.

Let me enumerate so many advantages of Embolization over Surgery:

• Embolization is totally done under local anesthesia.
• No need for any harmful anesthesia drugs.
• Patient is totally awake and can see the entire procedure on computer screen.
• No pain during procedure except for a single tiny injection (similar to any other injection like vaccine) to deliver local anesthesia.
• No cut or scar required.
• No blood loss or No need for blood transfusion.
• Same day discharge.
• No need for any Rest after embolisation.
• Patient can resume normal activity from same day.
• Embolization is entirely done from within the vein, hence  unlike surgery there is no risk of injury to artery or lymphatics.
• No risk of testicular injury or necrosis (gangrene).
• No risk of hydrocele.
• Comparable cost with Open surgery.
• Success rate is equal or even better than surgery.
• Chance of Recurrence and Failure is less when compared to surgery. I have treated many cases of failed surgery by embolisation technique.
• The biggest advantage of embolisation is that each and every step is done under fluoroscopy (like camera) visualisation and hence no abnormal vein is missed or left out without treatment.

All the above mentioned advantages of embolisation are practical and favour patient comfort, recovery and success rate. The actual procedural steps of embolisation will be explained in depth during OPD consultation. It is my sincere advice to all the patients diagnosed with varicocele that please don’t be shy of your problem. Consult a specialist like Dr Virender Sheorain ( Vascular and Interventional Radiology expert) and discuss in detail about your problem and best available treatment options.

If you are looking to treat your varicocele without surgery please feel free to consult or take second opinion online ( veeru40395@gmail.com or Whatsapp 9868887666 ) or in-person with Dr. Sheorain at his OPD in Medanta Hospital Sector 38 Gurgaon, India.

Go4Embolization
“Avoid Open Surgery and a Scar”