A varicocele is a collection of enlarged (dilated) veins within the scrotum, similar to varicose veins in the legs. These veins, known as the pampiniform plexus, normally drain blood away from the testicle. When the valves within these veins fail, blood pools and the veins become swollen, creating a varicocele.
Varicoceles are remarkably common, affecting approximately 15% of all men and up to 40% of men being evaluated for infertility. They occur most frequently on the left side (around 85% of cases) due to the anatomy of the left testicular vein, which drains at a right angle into the left renal vein. Bilateral varicoceles occur in approximately 15% of cases.
While many varicoceles are asymptomatic and discovered incidentally, they can cause significant scrotal pain and discomfort, and are the most common correctable cause of male infertility. The elevated temperature and impaired blood flow created by a varicocele can adversely affect sperm production and quality.
Varicoceles range from small and asymptomatic to large and symptomatic. When symptoms do occur, they typically include:
A dull, dragging ache in the scrotum that worsens after prolonged standing, physical exertion, or as the day progresses. Often relieved by lying down.
Enlarged veins that can be seen or felt within the scrotum, often described as feeling like a “bag of worms.” More prominent when standing or during Valsalva manoeuvre.
A sense of fullness or weight in the scrotum, particularly noticeable in warm weather or after exercise. May be accompanied by visible swelling.
Abnormal semen analysis results including reduced sperm count, decreased motility, or altered morphology. Varicocele is the most common treatable cause of male infertility.
In more advanced cases, the affected testicle may shrink due to impaired blood flow and elevated temperature. This is sometimes identified during routine examination.
Pain or discomfort during or after physical activity, particularly weight training, running, or prolonged standing. May limit exercise capacity and quality of life.
Diagnosis begins with a thorough clinical assessment and is confirmed with targeted imaging. The workup typically includes:
Physical examination performed standing and during Valsalva manoeuvre (bearing down). Varicoceles are graded from Grade I (palpable only with Valsalva) to Grade III (visible through the scrotal skin). Your referring urologist or GP will typically perform this assessment.
The primary imaging investigation. Ultrasound confirms the presence and size of dilated veins (typically >3mm) and Doppler assessment demonstrates reflux (retrograde blood flow) during Valsalva. This also assesses testicular size and excludes other scrotal pathology.
For men undergoing fertility evaluation, a semen analysis assesses sperm count, motility, and morphology. This provides a baseline that can be compared following treatment to monitor improvement.
Dr Rogan reviews your symptoms, examination findings, imaging, and (where applicable) semen analysis to determine whether embolisation is the right treatment for you. A clear plan is discussed, and any questions are answered in full.
Access is gained through a tiny puncture in the neck (jugular vein) or groin (femoral vein) — no scalpel, no stitches. This means minimal scarring, less pain, and reduced risk of wound complications compared to open or laparoscopic surgery.
Performed under local anaesthesia with conscious sedation, avoiding the risks, costs, and recovery time associated with general anaesthetic. You remain comfortable throughout the procedure.
Most patients go home within a few hours of the procedure. Return to desk work within 24–48 hours and light exercise within a week — significantly faster than surgical recovery.
Unlike surgery, which typically addresses one side at a time, embolisation can treat bilateral varicoceles in a single procedure through the same access point.
Clinical studies demonstrate that embolisation has technical success rates exceeding 95%, with symptom improvement and fertility outcomes comparable to surgical varicocelectomy.
Dr Rogan reviews your symptoms, clinical examination findings, and scrotal ultrasound results. If fertility is a concern, your semen analysis is also reviewed. A clear treatment plan is discussed and all your questions are answered.
Under local anaesthesia with light sedation, a small catheter is inserted through a tiny puncture in either the jugular vein (neck) or femoral vein (groin). Using real-time X-ray guidance (fluoroscopy), the catheter is navigated through the venous system to the testicular (gonadal) vein.
Contrast dye is injected to precisely map the abnormal veins (venography). Tiny metallic coils and/or a sclerosing agent are then deployed to permanently block the incompetent veins. Blood is naturally rerouted through healthy alternative pathways. The entire procedure typically takes 45–60 minutes.
You rest for 1–2 hours in recovery, then go home the same day. Most patients return to desk work within 24–48 hours and light exercise within a week. Heavy lifting should be avoided for approximately two weeks. A follow-up ultrasound is arranged at 6–8 weeks to confirm technical success, and semen analysis is repeated at 3 months if fertility was a concern.
Experiencing scrotal pain, heaviness, or discomfort that impacts daily life, exercise, or work. Embolisation provides effective symptom relief with rapid recovery.
Varicocele is the most common treatable cause of male infertility. Embolisation can improve sperm count, motility, and morphology, enhancing the chances of natural conception or improving outcomes with assisted reproduction.
Those who want to avoid open surgery, general anaesthesia, and prolonged recovery. Embolisation offers an effective alternative with minimal downtime.
Varicocele recurrence following prior surgical varicocelectomy can be effectively treated with embolisation, which approaches the problem from within the vein itself rather than through the same surgical field.
Book a consultation with Dr Rogan to find out if varicocele embolisation is the right treatment for you.