Varicocele and Pelvic Congestion Syndrome treatment
Varicocele
According to the Society of Interventional Radiology (SIR), thousands of men are needlessly undergoing surgery each year to treat a major cause of male infertility.
Among infertile couples, 30% of the men have varicoceles, which are varicose veins in the testicle and scrotum that may cause pain, testicular shrinkage, and fertility problems. And, as many as 70,000-80,000 men in America annually may undergo surgery to treat their varicocele, rather than nonsurgical embolization.
Open surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles. Varicocele embolization, which is performed by an interventional radiologist, is a highly effective, widely available technique to treat symptomatic varicoceles that is greatly underused in the United States, claims SIR.
Varicocele embolization is an outpatient procedure with a 2-day recovery period, compared to surgery that has an overnight hospital stay and 2-3 weeks of recovery. Additional benefits of embolization include no surgical incisions or stitches, no general anesthesia, and no infection. Most men with varicoceles are candidates for embolization and should obtain a second opinion with an interventional radiologist to understand their options, SIR recommends.
Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele.
Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. Some experts believe these blocked and enlarged veins around the testes cause infertility by raising the temperature in the scrotum and decreasing sperm production.
According to SIR, embolization is equally effective in improving male infertility and costs about the same as surgical ligation. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy. In one study, 60% conceived who were treated for infertility. In another study, sperm concentration improved in 83% of patients undergoing embolization compared to 63% of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.
Currently, there are two treatment options for men with varicoceles: catheter-directed embolization or surgical ligation. Catheter-directed embolization is a nonsurgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild intravenous sedation and local anesthesia, patients are relaxed and pain-free during the approximately 2-hour procedure.
For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so he or she can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, balloons, or particles, the physician blocks the blood flow in the vein, which reduces pressure on the varicocele. By embolizing the vein, blood flow is redirected to other healthy pathways. Essentially, the incompetent vein is "shut off" internally by preventing blood flow, accomplishing what the urologist does, but without surgery.
With surgical treatment of varicocele, the patient receives anesthesia, then an incision is made in the skin above the scrotum, cutting down to the testicular veins, and tying them off with sutures. Although patients leave the hospital the same day, there is a 2- to 3-week recovery period.
Non-Surgical Procedure is Effective Treatment for Painful Ovarian Varicose Veins
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is "all in their head" but recent advancements now show the pain may be due to hard to detect varicose veins in the pelvis, known as pelvic congestion syndrome.
The causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don't close properly, this allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva. Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.
The diagnosis if often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.
Many women with pelvic congestion syndrome, spend many years trying to get an answer to why they have this chronic pelvic pain. Living with chronic pelvic pain is difficult and affects not only the woman directly, but also her interactions with her family, friends, and her general outlook on life. Because the cause of the pelvic pain is not diagnosed, no therapy is provided even though there is therapy available.
Prevalence
Women with pelvic congestion syndrome are typically less than 45 years old and in their child bearing years.
Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.
Chronic pelvic pain accounts for 15% of outpatient gynecologic visits.
Studies show 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15% have PCS along with another pelvic pathology.
Risk Factors
Two or more pregnancies and hormonal increases
Fullness of leg veins
Polycystic ovaries
Hormonal dysfunction
Symptoms
The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:
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