Varicocele and Pelvic Congestion Treatment - Embolization

Varicocele and pelvic congestion syndrome treatment involves interventional closure of dilated pelvic and gonadal veins.

What is Varicocele?

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Varicocele is the abnormal enlargement of veins in the pampiniform plexus around the testicle. It occurs in 15-20% of men and is the most common treatable cause of male infertility.

Prevalence:

• General male population: 15-20%
• Infertile men: 40%
• Secondary infertility: 80%

Varicocele Anatomy

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Internal Spermatic Vein
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   Left: Drains to Renal Vein
   Right: Drains to IVC
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Pampiniform Plexus (Around testicle)

Left side dominance (85-90%):

• Left internal spermatic vein drains at right angle to renal vein
• Longer distance
• Nutcracker effect

Varicocele Grading

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Varicocele Symptoms

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Signs and Symptoms

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• Scrotal pain/discomfort: Most common
• Heaviness sensation: Especially when standing
• Testicular atrophy: Long-term
• Infertility: Impaired sperm quality

Infertility Mechanisms

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1. Increased testicular temperature
2. Venous stasis and hypoxia
3. Adrenal metabolite reflux
4. Increased reactive oxygen species

Varicocele Diagnosis

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Physical Examination

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• Standing examination
• “Bag of worms” appearance
• Prominent with Valsalva

Imaging

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Scrotal Doppler US:

• Primary diagnostic method
• Vein diameter >3 mm
• Reflux with Valsalva

Criteria:

• Vein diameter ≥3 mm
• Reflux duration >1 second
• Multiple dilated veins

Pelvic Congestion Syndrome

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Definition

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Pelvic Congestion Syndrome (PCS) is chronic pelvic pain caused by dilation of ovarian and pelvic veins in women.

Epidemiology

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• 30% of chronic pelvic pain
• More common in reproductive-age women
• Increased in multiparous women

Pelvic Congestion Symptoms

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Pain Characteristics:

• Chronic, dull pelvic pain
• Worsens with standing
• Worsens after intercourse (dyspareunia)
• Intensifies before menstruation
• Relieved by lying down

Associated Findings:

• Vulvar varices
• Leg varicose veins
• Dysmenorrhea
• Dysuria (painful urination)

Pelvic Congestion Diagnosis

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Transabdominal/Transvaginal US:

• Dilated ovarian veins (>6 mm)
• Dilated arcuate veins
• Uterine congestion

MR Venography:

• Detailed anatomy
• Non-invasive
• Treatment planning

Pelvic Venography:

• Gold standard
• Same session treatment possible

Interventional Treatment

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Varicocele Embolization

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Technique:

1. Access: Femoral or jugular vein
2. Catheterization: Selective internal spermatic vein
3. Venography: Anatomy assessment
4. Embolization:
   • Coils (metal spirals)
   • Sclerosing agent (polidocanol)
   • Glue (tissue adhesive)
5. Control venography

Embolic Materials:

Pelvic Congestion Embolization

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Target Veins:

• Ovarian veins (bilateral)
• Internal iliac vein branches
• Pelvic varices

Technique:

1. Femoral or jugular access
2. Left ovarian vein catheterization
3. Venography
4. Coil + Sclerosant embolization
5. Right ovarian vein procedure
6. Internal iliac branches (if needed)

Treatment Outcomes

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Varicocele Embolization

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Pelvic Congestion Embolization

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Embolization vs Surgery

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Post-Procedure Care

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Early Period

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• Daily activities: 24-48 hours later
• Heavy activities: Avoid for 1 week
• Sexual activity: After 1 week

Medications

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• Analgesics: Paracetamol/NSAIDs
• Antibiotics: Not routinely recommended

Follow-up

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• Month 1: Clinical evaluation
• Month 3: Doppler US + Semen analysis
• Month 6: Semen analysis

Complications

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Early

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Late

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• Recurrence: 5-10% (re-embolization)
• Testicular atrophy: Rare
• Hydrocele: Rare

Special Situations

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Bilateral Varicocele

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• Can be treated in same session
• Jugular access preferred
• Both internal spermatic veins embolized

Post-Recurrence

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• Collateral veins
• Re-embolization possible
• High success rate

Adolescent Varicocele

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• Testis volume difference >20%
• Ipsilateral testicular atrophy
• Progressive varicocele

Frequently Asked Questions

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Appointment and Contact

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To schedule an appointment for varicocele or pelvic congestion evaluation and embolization treatment:

📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul, Turkey

📞 Phone: +90 212 665 50 50 (Extension: 4012)

This content has been prepared by Assoc. Prof. Habib Çil for informational purposes only. Please consult a cardiology specialist for accurate diagnosis and treatment.

Related Venous Interventions

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Other services related to varicocele and pelvic congestion treatment:

• Acute DVT Treatment - Deep vein thrombosis
• Chronic DVT Treatment - Post-thrombotic syndrome
• May-Thurner Syndrome - Iliac vein compression
• Dialysis Fistula Treatment - AV fistula interventions