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Is surgery necessary for varicocele?

Q: I am suffering from varicocele on the left side. It is painful at times. I have tried yoga and water treatment i.e. pouring water on the testicles by which the pain subsides. The doctor has recommended surgery, but I am afraid of surgery. Is there any other treatment for the same? I have heard about embolization for varicocele. Is it safer and more corrective than surgery?

A:A varicocele is a meshwork of distended and tortuos blood vessels in the scrotum, usually left-sided, due to dilatation of the spermatic vein. Varicocele is a well-recognized cause of decreased testicular function and occurs in approximately 15-20% of all males and in 40% of infertile males. The primary form of treatment for varicoceles is surgery. The presence of a varicocele does not mean surgical correction is necessary and indications for surgery include relieving significant testicular discomfort or pain not responsive to routine symptomatic treatment, reducing testicular atrophy and as a part of treatment for unexplained male infertility. Left untreated, a varicocele may cause progressive damage to the testes. The 3 common surgical approaches to correct it are transinguinal (groin), retroperitoneal (abdominal), and infrainguinal/infrapubic (below the groin). The preferred technique is the transinguinal approach with optical magnification to make sure that all contributory veins and testicular arteries are identified. The laparoscopic technique has potential risks and few benefits over the transinguinal approach. Percutaneous embolization by means of balloon or metallic coil has been shown to be a safe and effective alternative to ligation in treating varicoceles. It is valuable as a first line of treatment for paediatric varicoceles provided a skilled interventional radiologist is available. This procedure is less invasive, avoids general anaesthetic, involves minimal postoperative pain, and allows an earlier return to normal activities. However, upto 35% of patients eventually require conventional surgery for primary failure of embolisation or late recurrence.

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