Men’s Health

MEN'S HEALTH

Men have unique health issues.  At the Vascular Institute of Virginia we specialize in treating some of these unique conditions that can affect the male population.  Our services range from routine diagnostic exams, to in-depth consultations for men with Infertility, arterial/venous disorders, and those suffering from symptoms associated with Benign Prostatic Hyperplasia (BPH).

Prostate Artery Embolization

Prostate Artery Embolization (PAE) is a minimally invasive procedure for the treatment of benign prostatic hypertension (BPH) with lower urinary tract symptoms (LUTS).  Men suffering from urinary frequency, frequency at night (nocturia), urinary retention, blood in the urine (hematuria) , weak stream, difficulty going, and/or starting and stopping urination could potentially benefit from this procedure.  During PAE, the doctor makes a tiny incision in the groin and advances a small tube called a catheter, to the prostate artery. Microscopic beads are released into the artery, where they lodge and temporarily block blood flow to the prostate, causing it to shrink.  Shrinking the prostate can relieve the patient’s urinary symptoms.prostate_arterypic

Enlarged prostate, or benign prostatic hyperplasia (BPH) is the most common benign neoplasm, or new abnormal growth of tissue in men, with more than 50 percent of men aged 60–69 years and as many as 90 percent aged 70–89 years experiencing symptoms. As life expectancy increases, so does the occurrence of BPH.

As a man ages, the prostate gland slowly enlarges and may press on the urethra and cause the flow of urine to be slower and less forceful. Enlarged prostates cause urinary frequency, urgency, passing urine more often, particularly at night (also called nocturia), weakened stream and incomplete bladder emptying. Such symptoms can have significant negative impact in quality of life, leading many men to seek treatment.

The standard treatment for BPH is surgery, which requires general anesthesia and can cause complications, such as urinary incontinence, sexual dysfunction, impotence and retrograde ejaculation, in which semen enters into the bladder. PAE, which can be performed under light anesthesia, involves a treatment called embolization, which entails temporarily blocking blood flow to the arteries that supply the prostate.

During PAE, an interventional radiologist makes a tiny incision in the groin and advances a small tube called a catheter, to the prostate artery. Microscopic beads are released into the artery, where they lodge and temporarily block blood flow to the prostate, causing it to shrink.

prostate_arterypic2

 

Frequently Asked Questions:

  1. How do I know if I am a candidate for PAE?
  1. Is the procedure covered by my insurance?
  1. Do I receive anesthesia for the procedure? Is it a painful procedure?
  1. How long is the procedure?
  1. Do I need to have a Foley catheter for the procedure?
  1. Can I drive home?
  1. Do I need to get blood work or any other pre-procedure tests/exams before my PAE?
  1. Are the embolization particles permanent?
  1. Do the particles move? Ever go somewhere unintended?
  1. Do I need to follow-up with the doctor in the office?
  1. Are there additional charges for follow-ups?
  1. When can I return to work/physical activity/sexual intercourse?

 

Interested in pursuing having PAE as an option for you?

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Varicocele Embolization

A varicocele is a varicose vein of the testicle and scrotum that may cause pain, infertility in men, and possibly lead to testicular atrophy (shrinkage of the testicles).  It is a condition that affects approximately 10 percent of men.
In healthy veins within the scrotum, one-way valves allow blood to flow from the testicles and scrotum back to the heart. In a varicocele, these valves do not function properly and sometimes fail. This can cause a reverse flow of blood which stretches and enlarges the tiny veins around the testicle.  This tangled network of blood vessels, or varicose veins, is called a varicocele.       
varicocele_embolization

What are Varicocele Symptoms?

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. Usually (but not always) painful varicoceles are prominent in size.

 

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 from 50 percent to 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.

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, repair of the variocele is often recommended. The repaired testicle will return to normal size in many cases.

How are Varicoceles Diagnosed?

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” (see Figure 2).

When varicocele symptoms are not clearly present, the abnormal flow of blood can often be detected with 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.

What are my treatment options?

In the United States, varicocele treatment has traditionally involved open surgery, usually performed by a urologic surgeon, or urologist. In recent years, however, a safe and effective nonsurgical alternative called varicocele embolization is becoming the treatment of choice for many patients and their physicians.

varicocele_surgery1.) Varicocele Surgery:

Varicocele Surgery is usually performed under general anesthesia in an outpatient setting. Occasionally, the surgery is performed with a local anesthetic.

In this type of varicocele treatment, the surgeon makes an incision above the scrotum (or higher in the flank area) and cuts through the layers of tissue to expose the veins.

2.) Varicocele Embolization:

Unlike varicocele surgery, embolization requires no incision, stitches, or general anesthesia. Further, embolization patients almost never require overnight admission to the hospital. In addition, several studies have shown that embolization is just as effective as surgery. Studies have also shown that embolization patients return to full activities in a day or two, but varicocele surgery patients may need to avoid strenuous activity for several days or even weeks. Some complications of varicocele surgery, such as hydrocele (fluid around that testicle) and infection are virtually unheard of after embolization.

Varicocele embolization, a non-surgical treatment performed by an interventional radiologist, is as effective as surgery with less risk, less pain and less recovery time. Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options.

varicocele_embolization2
Figure- A platinum coil, delivered through the catheter, is placed in the affected vein,
then a sclerosing agent is injected to block collateral veins. This helps to prevent recurrences.

During the embolization, the doctor inserts a catheter into the jugular vein, in the neck, down into the faulty vein(s). Catheterization requires only a small nick in the skin for insertion and x-ray image guidance of the catheter to its target area. The catheter delivers Dacron filaments-bearing coils that clot the blood and seal the faulty vein. The use of the recently developed Sotradecol foam agent allows the radiologist to block even the smallest veins not previously accessible.

Frequently Asked Questions 

  1. What is a varicocele?
  1. What are the advantages of varicocele embolization versus varicocele surgery?
  1. Should all varicoceles be repaired?
  1. Will varicocele embolization improve my semen analysis?
  1. Will the varicocele repair procedure reduce my pain?
  1. What are the risks or complications of the procedure?
  1. Is the procedure painful?
  1. How long will I be in the office?
  1. What are my restrictions after the procedure?
  1. How much work will I miss?
  1. Will the procedure affect sexual function?
  1. Is there a chance that the varicocele will recur after varicocele repair?
  1. I had varicocele surgery but my varicocele has come back. Can varicocele embolization help me?
  1. What does varicocele embolization cost?
  1. Will my insurance pay for varicocele embolization?
  1. If x-rays are used to guide varicocele embolization, is there a danger of radiation exposure?
  1. During varicocele surgery, there is an incision made in or near the scrotum. Is there one made during varicocele embolization?