Varicocele: can it be treated without surgery
Yes: varicocele can be treated without a cut and without general anaesthesia. Percutaneous embolization closes from the inside the vein responsible for the reflux, through a puncture of a few millimetres, under radiological guidance. In Milan I perform this procedure using cyanoacrylate as the embolic agent.
When to treat it
- Feeling of heaviness or testicular pain, more intense in the evening or after sport
- Palpable dilated veins, confirmed by colour-Doppler ultrasound
- Semen analysis changes during a fertility work-up
- Varicocele recurring after previous surgery
How it is performed, step by step
- 1. Consultation and colour-Doppler ultrasound. We confirm the venous reflux and review together the imaging, symptoms and, if available, the semen analysis.
- 2. Local anaesthesia and access. Only the skin is anaesthetized; through a venous puncture a thin catheter is introduced.
- 3. Study of the spermatic vein. With a small amount of contrast the refluxing circulation is mapped precisely, including the collateral veins that escape surgery.
- 4. Closure with cyanoacrylate. The glue occludes the vein immediately and stably, interrupting the reflux towards the testicle.
- 5. Going home. A few hours of observation and you go home the same day, with no wound to dress.
Embolization or surgery?
| Embolization | Surgery | |
|---|---|---|
| Anaesthesia | Local | Loco-regional or general, depending on the technique |
| Access | Venous puncture of a few millimetres | Surgical incision |
| Scar | No surgical scar | Inguinal or scrotal scar |
| Admission | Day-case: home the same day | Day surgery or short stay |
| Guidance | Real-time radiological imaging | Direct vision or microscope |
Neither option is always better: the choice depends on the venous anatomy, symptoms and goals (pain or fertility). During the consultation I tell you frankly which pathway best suits your case.
Frequently asked questions
Can varicocele be treated without surgery?
Yes. Percutaneous embolization treats varicocele without an incision: the internal spermatic vein is reached with a microcatheter introduced through a small venous puncture and closed from the inside. There is no surgical cut, no general anaesthesia is needed and no scar remains.
What is the difference between embolization and surgery?
Surgery (ligation or sub-inguinal microsurgery) involves an incision and, often, loco-regional or general anaesthesia. Embolization is performed under local anaesthesia through a puncture of a few millimetres, with usually a faster recovery and no wound to dress. The goal is the same: to interrupt the venous reflux towards the testicle.
Is it painful?
The procedure is performed under local anaesthesia. A feeling of tension or transient discomfort in the groin or lumbar area may be felt while the vein is closed. In the following days a mild soreness may persist, manageable with a common painkiller.
Why do you use cyanoacrylate?
Cyanoacrylate is a glue that occludes the vein immediately and stably. Compared with metal coils and sclerosing agents it allows shorter procedure times and durable occlusion, without leaving permanent metallic material.
When can I return to work and sport?
Daily activity and sedentary work usually resume within a few days. For sport and intense exertion it is advisable to wait about one to two weeks, depending on how recovery proceeds.
Is it useful for fertility?
In patients with varicocele and altered semen analysis the treatment can improve seminal parameters. Published data describe average results in groups of patients and do not guarantee an individual outcome: the assessment must be made together with the andrologist, with the semen analysis and colour-Doppler ultrasound to hand.
How much does it cost and in what setting is it performed?
It depends on the setting: some procedures are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment.
Want to know if you are a candidate?
Bring the colour-Doppler ultrasound and, if available, the semen analysis to the consultation: we assess the indication together.
Find out more
The information on this page is for general guidance and does not replace a medical consultation. The indication for treatment must always be assessed individually.