Varicocele
Gonadal Vein Embolization
Varicocele Embolization is an interventional radiology treatment for varicoceles that involves no incision near the genitals. It works by closing off blood flow to the affected vein(s), causing the varicocele to shrink.
What is Varicocele Embolization?
During Varicocele Embolization, a doctor positions a catheter (thin tube) through a small needle puncture in the leg and into the varicocele vein using X-ray guidance. A dye is injected to create an X-ray map (venogram) of the vein and tiny metal coils are inserted through the catheter to block the flow of blood to the vein.
What are Varicocele Symptoms?
How are Varicoceles Diagnosed?
Typical symptoms are mild and many do not require treatment. Treatment may be necessary if the varicocele is causing discomfort or any of the other problems listed below.
1.) Pain:
One of the signs of varicoceles is an aching pain when the individual has been standing or sitting for an extended time and pressure builds up in the affected veins. Heavy lifting may make varicocele symptoms worse and, in some cases, can even cause varicoceles to form.
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2.) Fertility Problems:
There is an association between varicoceles and infertility or subfertility, but it is difficult to be certain if a varicocele is the cause of fertility problems in any one case. In one study, as many as 40 percent of men who were subfertile were found to have a varicocele. Other signs of varicoceles can be a decreased sperm count; decreased motility, or movement, of sperm; and an increase in the number of deformed sperm. It is not known for sure how varicoceles contribute to these problems, but a common theory is that the condition raises the temperature of the testicles and affects sperm production. Studies have shown that 50-70 percent of men with fertility problems will have a significant improvement in the quality and/or quantity of sperm production after they have undergone varicocele repair.
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3.) Testicular Atrophy
Atrophy, or shrinking, of the testicles is another of the signs of varicoceles. The condition is often diagnosed in adolescent boys during a sports physical exam. When the affected testicle is smaller than the other, treatment is often recommended. The repaired testicle will return to normal size in many cases.
Sometimes a varicocele can be diagnosed during a physical examination. A large varicocele may make the scrotum look lumpy so it resembles “a bag of worms”.
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When varicocele symptoms are not clearly present, the abnormal flow of blood can often be detected with a varicocele ultrasound, a noninvasive imaging exam called color flow ultrasound. Varicoceles also may be detected with a venogram – an x-ray in which a special dye is injected into the veins to “highlight” blood vessel abnormalities.
Advantages of the Embolization technique
Recovery from embolization is much faster than invasive surgery because there is no incision to heal or stitches to be removed. The complication rate for Varicocele Embolization is only 0-1%, compared with 1-3% for surgery. Recovery typically takes less than 24 hours and patients often return to work the next day.
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Compare that to varicocelectomy, where patients may need to avoid strenuous activity for several days or even weeks. Some complications of varicocelectomy, such as hydrocele (fluid around the testicle) and infection are virtually unheard of after Varicocele Embolization.
For those concerned about fertility, Varicocele Embolization is as effective as surgery (as measured by improvement in semen analysis and pregnancy rates).
Frequently Asked Questions
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What Happens During The Aquablation Procedure?Aquablation therapy is performed in a hospital. You will be under anesthesia for the entire procedure. The procedure typically takes less than an hour and involves an overnight stay. There are two key steps to the procedure—creating a surgical map and removing the prostate tissue.
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What Happens Immediately After The Aquablation Therapy?As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7. 3. Data on file at PROCEPT BioRobotics.
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What Is Recovery Like After Aquablation Therapy?As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3 Once you’re home, you may experience mild burning during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor. References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7. 3. Data on file at PROCEPT BioRobotics.
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What Is The Cost Of Aquablation Therapy?The cost of Aquablation therapy will depend on what country you live in and what type of insurance you have.
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Does My Insurance Cover Aquablation Therapy?For patients in the United States, two of the major national private insurance companies (Anthem and Humana) have issued positive coverage policies for its patients. For all other private insurance companies, coverage can be assessed on an individual basis, and you should speak with your provider directly to determine if Aquablation therapy is available for you. For patients outside of the United States, reimbursement and coverage vary by geography. We recommend patients contact their local physician providers to determine if Aquablation therapy is available.
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What Is Aquablation Therapy?Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera (called a cystoscope) with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is, and has a very low rate of irreversible complications—incontinence, ejaculatory dysfunction, erectile dysfunction.1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
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Who Is An Appropriate Candidate For Aquablation Therapy?Aquablation therapy has been proven as a safe and effective treatment for patients suffering from lower urinary tract symptoms (LUTS) due to BPH. Aquablation therapy can be performed on prostates of any size.
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Who Performs Aquablation Therapy Surgery?Your urologist performs Aquablation therapy using the AquaBeam Robotic System. The procedure takes place in a hospital. When our team performs embolization prior to Aquablation therapy, the PAE will be performed by a Vascular Interventional Radiologist
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How Common Is Aquablation Therapy Surgery?Aquablation therapy is commercially available in the United States, Canada, Europe, United Kingdom, the Middle East and Asia.
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Is Aquablation Therapy FDA Approved?Yes, Aquablation therapy is performed by the AquaBeam Robotic System, which was cleared by the FDA in December 2017.
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Does Aquablation Therapy Have CE Mark?Yes. Aquablation therapy is performed by the AquaBeam Robotic System, which received CE Mark in 2014.
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What Are The Risks Associated With Aquablation Therapy?The most common side effects are mild and temporary. These may include mild pain, bleeding or strain while peeing, discomfort in the pelvis, inability to empty the bladder, a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum. For more information about potential side effects and risks associated with Aquablation therapy, speak with your urologist or surgeon. With the most significant risk in clinical studies being bleeding, the team has worked to improve this outcome by performing PAE or embolization prior to Aquablation. This has been performed with clinical results showing an improvement in bleeding rate, discharge to home, and complications compared to published studies.
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What Are The Clinical Results?Aquablation therapy has been studied in seven different clinical trials. It has been shown to be a safe and effective treatment for patients suffering from lower urinary tract symptoms (LUTS) due to BPH. Aquablation therapy can be performed on prostates of any size. References: 1. NCT03191734 – French Aquablation Clinical Investigation Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue 2. NCT03123250 – Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue II (WATERII) 3. NCT02974751 – Global Post-Market Registry Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (OPEN WATER) 4. NCT02505919 -Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (WATER) 5. NCT03167294 – AquaBeam India Study for the Treatment of Benign Prostatic Hyperplasia (ABS) 6. NCT03125863 – Acute Hemostasis Following the Use of the AquaBeam® System for the Treatment of Benign Prostatic Hyperplasia (AHA) 7. NCT03125889 – Acute Hemostasis Following the Use of the AquaBeam® System for the Treatment of Benign Prostatic Hyperplasia II (AHA II)
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What Is The AquaBeam Robotic System?The AquaBeam Robotic System performs Aquablation therapy.
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Why Is The AquaBeam Robotic Surgery Better?Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera (called a cystoscope) with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is. It has a very low rate of irreversible complications—incontinence, ejaculatory dysfunction, erectile dysfunction.1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
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Does The Treatment Impact Sexual Function?Aquablation therapy has a very low rate of irreversible complications (incontinence, ejaculatory dysfunction, erectile dysfunction).1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
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What Are The Side Effects?Once you’re home, you may experience mild burning sensation and urgency during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor.
