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The goal of the varicocele treatment is to close the refluxing vein(s) without harming the normal veins, lymphatic channels and testicular arteries. Embolization is the only treatment method that can achieve all aspects of this goal. In embolization, complications such as hydrocele, testicular damage and infection has not been reported. Normal veins are not closed since abnormal veins can be readily differentiated with venography. By contrast, surgical operation has always such risks, but the probability may differ depending on the type of operation.

According to the literature, more than 90% of varicocele patients can be successfully treated with both embolization and surgery. Similarly, improvements in sperm parameters and pregnancy rates are nearly the same for both treatments. The only difference is that embolization is much easier and more comfortable for the patient and does not have the risks mentioned above, which are associated with surgery.

It has been reported that with microsurgical techniques which have recently been started to use in certain centers, the complications of surgery have declined. However, despite a drop in their frequency, complications still occur and there is a big variation in the reported complication rates of different centers. Besides, like other varicocele operations, microsurgery too has the same limitation regarding the identification of normal and abnormal veins; since there is no method to reliably differentiate the refluxing veins during surgery, almost all veins around the testicle have to be ligated to achieve a reasonable recurrence rate.

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In light of the information provided above, we believe that our patients should consider the following when deciding on the type of varicocele treatment for themselves (*).

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• Unilateral (one-sided) varicocele: Both embolization and surgery are effective although we believe that embolization is more advantageous due to reasons we mentioned earlier.

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• Bilateral (both-sided) varicocele: Embolization should be the first choice treatment since it is possible to treat both varicoceles through the same entry site in the same session.

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• Isolated right varicocele: It is very rare and can be treated with both embolization and surgery.

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• Recurrent varicocele after surgery: This is a typical indication for embolization. Recurrent or persistant varicocele generally occurs due to ligation of the wrong vein during the surgery. In such a case, the second treatment must have the ability to correctly identify the refluxing vein and this can be best done with venography. This vein can then be closed with embolization in the same session.

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• Recurrent varicocele after embolization: It is generally due to occurrence of new refluxing veins and such veins can be closed with both surgery and embolization.

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• Varicocele that can not be treated with embolization: In about 2% of varicocele patients, it may not be possible to reach the refluxing veins through the vessels. In such cases, surgery can be successfully performed.

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(*) These recommendations reflect the opinion of our team and those of the interventional radiologists that perform varicocele embolization in the world. They may be partially or totally disagreed by our colleagues from different specialties. We advise that our patients should consider different opinions from reliable sources when deciding on the type of treatment for their varicocele.

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