Justin Houman։ A Note for Colleagues Referring Men With a Clinical Varicocele
Justin Houman, Men’s Health Urologist at Tower Urology at Cedars-Sinai Medical Center, shared on LinkedIn:
“A note for colleagues referring men with a clinical varicocele.
Patients arrive having heard two answers: the urologist recommends microsurgical varicocelectomy, the interventional radiologist recommends embolization. Both are same-day outpatient procedures, and both work, depending on the patient and his goals.
The differentiator I weigh most is recurrence. In my practice, microsurgical subinguinal repair runs anywhere from 0.5 to 1 percent, against 10 to 13 percent for embolization. The reason is anatomical: under the microscope we can address the internal spermatic, external spermatic, and gubernacular collaterals, while a catheter can only treat the veins it can reach.
Two situations where I recommend embolization first: recurrence after a prior microsurgical repair, where reoperating through scar and altered planes is harder, and the uncommon patient who cannot tolerate anesthesia.
One point worth passing to patients as they read the literature: the data favoring each approach is published largely by the specialty that performs it. I’m a surgeon, and I say so up front.
Happy to see these patients from across the US, including by telemedicine.”
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