Varicocele is a cluster of varicose veins located around the testicle in males. In varicocele, there is another vessel that leaks deoxigenated blood back into the testicle and cause varicocele formation. So for a good treatment in varicocele, we have to correct both the incompetent vein that causes varicocele and also the varicocele itself. In surgical operations, the surgeon can treat either the refluxing incompetent vein (classic surgery) or the varicocele itself (microsurgery). In classical operations, the refluxing vein, which is in most cases the internal spermatic vein, is closed surgically via a small incision in the groin. In microscopic surgical operation, the scrotum is opened and the varicocele itself is tied up and removed surgically. So in surgery, you either threat the incompetent vein that causes varicocele or the varicocele itself.
Embolization has a number of advantages in varicocele treatment. It is done under local anesthesia and after the treatment, the patient may be discharged in one hour. But the most important advantage of varicocele embolization is that in one single session, we are able to treat both the varicocele and the vessel that causes varicocele. How do we do this? Via angiography, we put a small catheter into the incompetent vein, and through this catheter, we advance a small microcatheter first down into the varicocele, and there we inject a sclerosing agent (polidocanol foam) to make the varicocele veins smaller by time. This process is called sclerotherapy. Then, we draw back the microcatheter inside the incompetent internal spermatic vein and we inject glue to occlude this vein. When the procedure is completed, we would have treated both the varicocele and the vessel that causes varicocele in one session without operation.