[Varicocele: comparison of minimally invasive treatment options : Endovascular embolization, microsurgery, and patient-tailored treatment selection].

Abstract

Background: Varicocele is the most common potentially treatable cause of male subfertility. Endovascular embolization is an established minimally invasive alternative to microsurgical ligation.

Objective: To place the indications, technique, outcomes, and limitations of varicocele embolization in context and to define its role relative to microsurgery.

Materials and methods: Narrative, guideline- and evidence-based review of current WHO, EAU, AUA/ASRM, and CIRSE recommendations, systematic reviews, meta-analyses, and relevant cohort studies published through July 2026.

Results: Treatment is primarily indicated in men with a palpable varicocele, abnormal semen parameters, and otherwise unexplained infertility; subclinical varicoceles and normal semen analyses do not justify intervention. Technical success of embolization is usually above 90% in experienced centers. Pregnancy rates are broadly similar to those after surgery, while overall morbidity tends to be lower. Recurrence may, however, be more frequent than after high ligation. No embolic agent has proved consistently superior.

Conclusion: Varicocele embolization is an evidence-based alternative to surgery, particularly for recurrent disease, bilateral or complex venous anatomy, and when rapid recovery is a priority. Treatment should be selected through multidisciplinary, anatomy-based, and shared decision-making.