Varicoceles can cause various problems, including subfertility.

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1 This leaflet has been provided to help answer some of the questions you or those who care for you may have about percutaneous abscess drainage. It is not meant to replace the consultation between you and your healthcare team, but aims to help you understand more about what you discussed together. A testicular varicocele is an abnormality of the veins that take blood away from the testicles. The veins become more obvious, rather like varicose veins in the leg. It is a relatively common condition (affecting approximately 25 percent of normally fertile men) and is much more common on the left side. It is not always clear why a varicocele develops. Sometimes these varicoceles cause no symptoms, but they may occasionally be associated with pain or a reduction in sperm count. It is a treatment in which the abnormally enlarged blood vessels (veins) draining your testicle are embolized (blocked) with small metal coils, which allows the veins to shrink and become less obvious. This will cause the varicocele to disappear without an operation. Varicocele embolization is performed under local anaesthetic through a vein in your neck or groin. The radiologist (X-ray doctor) performing the procedure will decide which is the best method for you. Varicoceles can cause various problems, including subfertility.

2 Varicocele embolization is a very safe and relatively quick procedure, designed to improve your medical condition and prevent you from having a more invasive operation. One of the benefits of varicocele embolization is that it improves pain and discomfort associated with varicocele. It may also improve subfertility. There are some complications or risks associated with the procedure: With large varicoceles, some swelling may occur around the testicle shortly after the treatment and may persist for a few days Bleeding or bruising around or from the insertion site in your neck or groin (0.5 percent or one in 200 patients) Infection at the insertion site (0.1 percent or one in 1,000 patients) Reaction to the contrast medium (special dye used in varicocele embolization). This is very rare and occurs in percent or one in 40,000 patients A five to ten percent chance of the problem recurring. If this happens, the procedure may need to be repeated, or you may be advised to have an operation. The radiologist (X-ray doctor) will discuss the risk factors relevant to your particular condition with you before starting the procedure. They will be happy to answer any questions you may have. Varicoceles may be treated by conventional surgery, but embolization is now the preferred technique as it is less invasive and the results are just as good. You can take all your medications as usual, except blood-thinning tablets (such as warfarin or aspirin) or metformin (drug for diabetes). If you take blood-thinning medications or metformin, it is very important that you inform the ward staff or the imaging department staff before you come into hospital, as you may need to stop taking them before your appointment. Please also let us know if you have asthma or are allergic to any medications or the contrast medium (dye) used for varicocele embolization. We may ask you not to eat anything for four hours before your appointment time. However, you may drink clear fluids (such as water, black tea or black coffee) during this time. Your appointment letter will give you further information about this. If you are having the procedure as an outpatient, you must arrange for someone to take you home afterwards, as you should not drive or travel alone on public transport after an embolization. You may need to have a blood test before you come for your varicocele embolization. If required, this will either be done on the ward or in the pre-admission assessment clinic. If the radiologist decides to carry out the procedure via the vein (blood vessel) in your groin, you will be asked to shave this area. 2

3 Please contact us as soon as possible. We can then offer this date to another patient and agree a new appointment date and time with you. You will find the appropriate telephone number on your appointment letter. You are advised to travel, if possible, by public transport when visiting our hospitals. Car parking is severely limited and you may find it very difficult to find a place to park near the hospital. The nearest tube stations for Hammersmith Hospital are East Acton and White City (both on the Central Line) and Wood Lane (Hammersmith & City Line). Buses that stop outside the hospital are numbers 7, 70, 72, 272 and 283. The nearest tube stations to Charing Cross Hospital are Hammersmith (District, Piccadilly and Hammersmith & City lines) and Barons Court (Piccadilly and District lines). Buses that stop outside the hospital are numbers 190, 211, 220 and 295. The nearest stations to St Mary s Hospital are Paddington Mainline Station and tube station, whilst Edgware Road Underground stations are about 5 minutes walk away. St Mary s is served by bus routes 6, 7, 15, 16, 18, 23, 27, 36, 98 and 205. If you are having the procedure as an inpatient, you will be admitted to hospital and will be seen by the ward doctor and/or nurses before you come to the imaging (X-ray) department for your varicocele embolization. If you are having the procedure as an outpatient, we will ask you to come straight to the imaging (X-ray) department on the day of your varicocele embolization. The radiologist (X-ray doctor) will discuss the procedure with you in detail and ask you to sign a consent form. This is to make sure you understand the risks and benefits of having the embolization. You will be asked to change into a hospital gown. Staff in the imaging department will then check your details and examine you before taking you into the X-ray room. The imaging staff will ask you to lie on your back on the X-ray table before connecting you to a monitor, which will record your blood pressure and pulse throughout the procedure. Your groin or neck will be cleaned with antiseptic fluid and covered with a sterile drape (towel). The radiologist will give you an injection of local anaesthetic to numb the area. This may cause some stinging, but it will only last for a short time. When the area is completely numb, the radiologist will pass the catheter (fine, plastic tube) over a fine wire into the vein in your groin or neck. You may feel some pressure or pushing at the insertion site to begin with, but this should not be painful. If it does become uncomfortable at any time, tell the radiologist who may be able to give you some more local anaesthetic or painkiller. 3

4 When the catheter is in the correct position, the radiologist will inject the contrast medium. As the dye is injected into your blood vessels, X-rays will be taken. You may experience a warm sensation in your groin. This is normal and is nothing to worry about. The images (pictures) will highlight the blood vessels needing to be treated and the radiologist will block these areas with small metal coils. Please tell the nurse if you experience any pain during this time so that we can give you an injection to make you more comfortable. You may feel sick after the painkilling injection. This is normal and can be relieved with other medication. Varicocele embolization usually takes approximately 45 minutes to complete, but may take longer in some cases. Once the radiologist is satisfied, they will remove the tube and then press firmly on the insertion site (your groin or neck) for approximately ten to 15 minutes, to prevent bleeding and minimise bruising. You will remain in the recovery area within the X-ray department on a trolley or return to the ward. If you are an outpatient, the imaging nursing staff will continue to check your blood pressure, pulse rate and the puncture site regularly for a few hours following the procedure while you remain in bed or trolley. Once we are satisfied with your condition, you will be allowed to go home. If you are an inpatient, we will take you back to the ward and you will need to rest in bed for up to six hours. You will be able to have something to eat and drink. The nursing staff will continue to record your pulse and blood pressure during this time, as well as check your puncture site regularly. If you feel unwell during this time, you must tell the doctor or nursing staff. You may have a small amount of bruising where the catheter was inserted. However, if you notice any bleeding from the wound, you should lie down and press firmly on it and either contact your GP or go to your nearest accident & emergency (casualty) department as soon as possible. If you experience a high temperature or fever, pain or diarrhoea, you must contact your GP or go to your nearest accident & emergency (casualty) department. You may have an infection that needs to be treated as early as possible with antibiotics. This will depend upon the individual, but most patients recover within one week. However, we recommend that you avoid heavy lifting and strenuous exercise for the first 48 hours after your appointment. You may also be advised to avoid having sexual intercourse for a few days. 4

5 We aim to provide the best possible service and staff will be happy to answer any of the questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on or (Charing Cross and Hammersmith hospitals), or (St Mary s). The PALS team are able to listen to your concerns, suggestions or queries and are often able to help sort out problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: The Managing Director Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY Please do not hesitate to contact us if you have queries or concerns. Imaging department, Hammersmith Hospital Du Cane Road London W12 0HS Telephone: Imaging department, Charing Cross Hospital Fulham Palace Road London W6 8RF Telephone: Imaging department, St Mary s Hospital Praed Street, Paddington London W2 1NY Telephone: This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on Imaging Published: January 2014 Review date: January 2017 Reference no: 1195Tv5 Imperial College Healthcare NHS Trust 5