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Is varicocoele surgery better than varicocoele embolisation?

Q: The urologist has recommended my husband to undergo varicocoele surgery for his low sperm count and low motility. After searching I came to know that there are two different kinds of procedures for this treatment - varicocoele surgery and varicocoele embolisation. Please let me know, which one is better and more effective to solve our problem?

A:There are more than two methods to treat varicocoele. Instead of the methods what makes more sense is, where is the varicocoele being attacked. As you may be aware, these veins lie from the kidney level to the scrotum outside. As one comes nearer to scrotum, one encounters more and more veins. These veins can be tackled at: 1. Level below the kidney by embolisation or by laparoscopic ligation. Both are non-invasive methods, but results are the worst, and recurrence rates are high. 2. Mid level just before these veins emerge out of abdomen: usually by open surgery: called high ligation of varices, done with a small cut on two sides. Recurrence rates are lower than when varicocoele is done high up as above. 3. Tackling and ligating the veins nearer to scrotum: Done under microscope as veins are thinner and multiple (called microvascular varicocoelectomy). Results are best. There was a question asked to the expert panel in one of the international conferences as to how they would like their sons varicocoele to be operated? The unanimous answer was by microvascular varicocoelectomy.


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