What is a varicocele embolisation?

A varicocele is an abnormality of the veins that take blood away from the testicle. The veins become bigger and more obvious, rather like varicose veins in the leg.

Embolisation is a way of blocking these veins. This makes them less obvious and causes the varicocele to disappear without an operation.

Who has made the decision?

The consultant in charge of your care and the radiologist carrying out the varicocele embolisation will have discussed your symptoms. They feel that this is the best treatment option. You will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out then you can decide against it.

Who will be performing the varicocele embolisation?

A specially trained doctor called a radiologist. Radiologists have special expertise in using X-ray equipment and also in interpreting the images produced. They need to look at these images while carrying out the procedure.

Where will the procedure take place?

This will take place in the Imaging Department, Gate 19, as described in your appointment letter.

What happens before the procedure?

• You will need to have a blood test a few days before the procedure to check your kidney function, that you are not at increased risk of bleeding and that it will be safe to proceed. This may be arranged to take place at your GP surgery.  
• You can continue taking your normal medication.
• If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging Department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.
• You will also need to make sure that you have somebody to bring and collect you from the hospital, as you will not be able to drive immediately after the procedure.
• You must also ensure that there is a responsible person to be with you after and during the first night following the procedure in case you have any difficulties.

On the day of the procedure

• You should not eat anything from 4 hours before your procedure but you may continue to drink water.
• You will arrive at the Imaging Department, Gate 19, and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you have any allergies.
• A radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
• Once all the checks have been performed and consent signed, you will be taken to the angiography suite on the trolley. There will be a nurse, radiographer and a radiologist with you throughout the procedure.

During the procedure

• You will need to lie on your back on an X-ray table for the duration of the procedure.
• The skin near the neck or groin will be cleaned with an antiseptic solution and covered with sterile drapes.
• Using an ultrasound machine, the radiologist will then inject local anaesthetic into the skin and deeper tissues over the neck or groin. This will briefly sting and then go numb. Most people will feel a pushing sensation.
• A catheter (thin tube) is guided into the testicular vein with the help of the X-ray machine. Small, metal coils are then used to block off the abnormal testicular vein.
• Once the procedure is complete, the radiologist will remove the catheter and press gently on the entry site for a few minutes to prevent bleeding.
• The whole procedure will take around 40-60 minutes although treating both sides will take longer.

What to expect after the procedure

• You will be taken back to the day case unit, so that nursing staff may monitor you closely. They will let you know when you can eat, drink and mobilise.
• If you are feeling okay and your checks are normal, you may go home.

Are there any risks or complications?

Varicocele embolisation is a very safe procedure, but there are some risks and complications that can arise:

• There may occasionally be a small bruise around the site where the needle has been inserted. This is quite normal and should improve itself in a few days.
• It is possible that the site of injection may become infected. Contact your GP if you notice any redness
  at the injection site as this may need treatment with antibiotics.
• Some patients experience mild discomfort in the left flank (lower left part of your back) for a day or two, needing no more than simple painkillers, if anything.
• There is always the possibility that, although the varicocele seems to have been cured to start with, months or even years later, it may come back again. If this happens, then the procedure may need repeating or you may be advised to have an operation.

Despite these possible complications, the procedure is normally very safe and is performed with no significant side effects at all.

What about the metal coils?

The coils are made of platinum and look a bit like light bulb filaments. They will show up whenever you have an X-ray or CT scan but will not activate airport metal detectors. As they do not contain iron, it is safe should you ever need a Magnetic Resonance Scan (MRI).

Further information

We hope this information is helpful. If you have any questions, either before or after the procedure, the staff in the Imaging Department will be happy to answer them. The telephone number for the Imaging Department can be found on your appointment letter. 

Reference

British Society of Interventional Radiology (2011) “Varicocele embolisation Patient information”. BSIR - British Society of Interventional Radiology Accessed on 15/05/2020

© North Bristol NHS Trust. This edition published July 2023. Review due July 2026. NBT002077

HIV Medicine Service

The North Bristol NHS Trust HIV Service is based at Southmead Hospital, Bristol.

An HIV test can be done in many different healthcare settings, including at the GP or Bristol Sexual Health Centre. Early diagnosis and treatment has many health benefits. Where there are particular concerns around HIV testing, our team would be happy to discuss this.

Where patients are known to be HIV positive they should be referred to the HIV specialist nurses via email at brecon.nurses@nhs.net, which is also our preferred route for non-urgent HIV related queries.

If there are patient HIV related queries for the HIV team at North Bristol NHS Trust (Southmead) then we would prefer that patients email brecon.nurses@nhs.net, or alternatively phone 0117 414 6400 if they cannot email.

For confidential HIV testing and sexually transmitted infection (STI) screening visit https://yunosexualhealth.co.uk/. Patients may order free STI testing kits online for home use (if aged 16 or over and living in Bristol, North Somerset or South Gloucestershire). For some people it may be more appropriate to get an HIV test in a sexual health clinic.

Acutely ill HIV patients should be discussed with the HIV team or the hospital HIV on-call team for admission, contactable via switchboard at Southmead.

Conditions Treated:

•    Suspected acute HIV infection.
•    Post-Exposure Prophylaxis after Sexual Exposure to HIV (PEPSE) - referrals taken from other healthcare providers.
•    Chronic HIV infection.

Note this service is only for patients living with HIV and for those referred from other healthcare providers for continuation/discontinuation of PEPSE.

 Appointment Clinic Times are:
 Monday 12.00pm – 4.00pm
 Tuesday 2.00pm – 6.00pm
 Wednesday 12.30pm – 4.30pm
 Thursday 8.00am – 12.00pm

HIV Medicine Team

Specialty Director

Dr Philip Bright - Lead Clinician
Telephone (secretary): 0117 414 6395

Consultants

Dr Sarah Johnston
Dr Sathish Thomas-Williams
Dr Adele Wolujewicz 
Dr Ed Moran
Dr Ankur Gupta-Wright
Dr Bret Palmer
Dr Sarah Stockwell

Pharmacy Team

Jo Latimer (Pharmacist)
Arianwen Denham (Pharmacist)
Lisa Atkins (Pharmacy Technician)

Clinical Nurse Specialists/Health Advisors

Liz Williams
Elizabeth Richards
Phoebe Byrne

Research Nurses

Louise Jennings - Lead
Malgorzata Slowinska

Medical Secretaries

Tel: 0117 414 6394
Danielle Coombs
Sharon Hemming
Bozena Zelazowska

Administrators

Christina Fletcher
Laura Webb
Chloe Whitlock (Database)

Dieticians

Katherine Barker
Kathryn Campbell

HIV Medicine Service Useful Links

The team at NAM (National AIDS Manual) produce and distribute accurate, up-to-date and evidence-based resources (printed, electronic, audio and online), covering both the medical and social aspects of HIV, to people living with HIV and to those who work to treat, support and care for them. Visit Aids Map for more information.

A medicines interactions checker is available.

A charity called Brigstowe, based in Bristol, are dedicated to the help of patients living with HIV. As well as lots of information about HIV Brigstowe offer the following to patients living with HIV:

• A one-to-one advice and support service.
• A migrant and asylum service.
• Group peer support and a range of group workshops.
• One-to-one peer support.
• Clinic peer support.

Please contact Brigstowe on 0117 955 5038 or visit Brigstowe for further information, advice and support.

Peer support at clinic is provided by Brigstowe peer mentors to patients living with HIV. These are trained volunteers, also living with HIV, who will meet patients in a safe and confidential space at clinic. They can:

•    Check in with patients about appointments and any concerns patients may have
•    Chat with patients about treatment and managing side effects
•    Be a listening ear
•    Let patients know how Brigstowe can help
•    Share their own experiences and knowledge of living with HIV
•    Share coping strategies

Terence Higgins Trust (THT) is a national HIV and sexual health charity. They support people living with HIV and amplify their voices, and help the people using their services to achieve good sexual health.

In Bristol the Terrence Higgins Trust provides health promotion and prevention by sharing information and resources and working directly with communities. They also provide health and wellbeing support and work alongside Brigstowe, to support people living with HIV. 

• Health and well-being groups.
• A women's group.
• One to one support.
• Support over the phone.
• Online counselling.

Individuals may access THT themselves or referrals can be made by other agencies (telephone 0117 955 5038 or 0808 802 1221).

Last updated 30/09/2024

The Workforce Disability Equality Standard (WDES) is a set of ten specific measures (metrics) which enables NHS organisations to compare the workplace and career experiences of Disabled and non-disabled staff.  NHS trusts use the metrics data to develop and publish an action plan. It will enable us to demonstrate progress against the indicators of Disability equality.

Making a difference for Disabled staff

The WDES enables us to understand the experiences of our Disabled staff and support positive changes for all existing employees. NBT is committed to creating a more inclusive environment for Disabled people working and seeking employment in our Trust.

2023

2020/2021

"The actions plans are still in draft format as we are still working with our relevant staff networks and other stakeholders to finalise them in due course"

Video 1 - Sensing location

In sitting with your eyes closed ask a friend/ carer to touch your bare arms. Try to sense and point to which area was touched. Does the feeling vary between your arms and with different locations touched? Are you accurate in sensing the area touched? Repeat the process as often as able.

Video 1 - Ball throwing and catching in sitting

In a seated position, throw a ball up in the air in front of you and catch it. Ensure you are catching two handed or with your affected arm. Try to control the pace and direction of the throw to keep it close enough to catch. Tip: To make the exercise harder try using a smaller ball or catching one handed.

Video 2 - Ball throwing and catching in standing

Position yourself standing up. Practice throwing and catching a ball with both hands.

Video 3 - Standing eyes closed

Standing with your feet shoulder width apart stand with your eyes closed. Gradually try to increase the time to which you can tolerate without having to adjust your feet.

Video 4 - Standing eyes open on unstable surface

Standing with your feet shoulder width apart on an unstable surface (Cushion, wobble board). Gradually try to increase the time to which you can tolerate without having to adjust your feet. Try to imagine a glass resting on the cushion / wobble board, you are aiming to keep your weight evenly spread so a glass wouldn’t fall over.

Video 5 - Standing eyes shut on unstable surface

Standing with your feet shoulder width apart on an unstable surface (Cushion, wobble board) stand with your eyes closed. Gradually try to increase the time to which you can tolerate without having to adjust your feet.

Video 6 - Perch STS

For this you need to find a high chair, or bed that allows you to sit “perched” on the edge. The idea is that you are in a position that is in-between sitting and standing. This makes standing up easier. Set your self a target of how many of these you want to do in a row and when you are finding it easy you might progress to STS from a normal height chair.

Video 7 - Single leg stand

Stand next to a kitchen counter. Hover your hands over the counter, and shift your weight on to your affected leg. Maintain this single leg pose for as long as possible, without use of your hands for balance.

Video 1 - Finding objects

Using a bowl of rice bury small household objects. With your eyes closed dig around and try to pick the objects out. As an extra challenge try to identify the objects before you open your eyes.

Video 2 - Light touch vs deep touch massage

Video 3 - Position testing

Sitting down with your eyes closed, ask a friend to move your strongest arm into a position. With your eyes still closed mirror the same position with your other arm. Keeping your arms in position open your eyes, are your arms held in the same position? 

Video 4 - Rice-bean bowl exercise

Put some rice or dry beans in a bowl. Using a pair of tweezer try to pick the individual grains up and transfer them to another bowl.
Tip: the smaller the beans are the more difficult it gets

Video 5 - Sensing temperature

In sitting with your eyes closed ask a friend/ carer to touch your bare arms. Try to sense and point to which area was touched. Does the feeling vary between your arms and with different locations touched? Are you accurate in sensing the area touched? Repeat the process as often as able.

Video 6 - Sensory re-education of textures

Look around your home and pick a variety of objects with differing textures. Rub them over both the palm and the back of the hand affected by sensory loss, or impairment. Make sure to go over the finger tips and sides of fingers as well. This will help to stimulate sensation messages to the brain. Close your eyes and see if you can guess what is being used. Try textures such as cotton wool, a flannel, velvet, hair brush/comb, tooth brush, a tooth pick, Velcro, fleece, a woollen jumper etc

Video 7 - Stereognosis Box

Select some smallish items from around your house. Put them in a box and cover with a pillow case (this is so you can’t see what you are touching). Reach your hand into the box, without looking and feel for an item. See if you can work out what it is just from how it feels in your hand. Is it heavy or light, smooth or rough? Manipulate it in your hand to try and touch every part of it to help you work out what it could be. Once you think you know the answer, pull it out and see if you are correct! You can make this harder, by putting small items in rice and then feeling around in the rice for the objects and trying to work out what they are before looking.
 

Video 8 - Functional UL tasks – applying hand cream

Video 1 - Doing up laces

In a seated position, tie up the laces on both your shoes. Afterwards, untie them again. If it is too difficult to reach down to your feet, you can place some shoes on a table in front of you.

Video 2- Holding and sensing objects

Ask a caregiver when your eyes are closed to place everyday objects one at a time into your hand. Spend several seconds feeling the item, the texture, weight and temperature. Try to guess what the item is. Note down how many you’re able to identify.

You can do this on your own by feeling everyday objects in your affected hand with your eyes closed and concentrating for several seconds on how they feel.

Video 3 - Holding weights

In sitting with your eyes closed ask a caregiver to place a light object into your hand. Try to sense the weight of the object for a few seconds. Next switch to a heavy item, again feel its weight. Repeat the sequence; try to determine which object is heavier.

Video 4 - Picking up coins

Sit at a table with some coins laid out in front of you. Stack the coins with your affected hand. Then carefully remove them one by one.
Tip: You can vary the difficulty by using bigger or smaller coins.

Video 5 - Pouring water

Sit a table with two cups, one empty and one with some water in it. Hold the empty cup in your affected hand and the cup with water in the other hand. Pour the water back and forth between the cups, trying to keep both cups steady and not spilling any.
Tip: You can vary the amount of water in the cup to adjust the difficulty.

Video 6 - Ripping paper

Take some scrap paper. Practice picking the paper up with your affected hand and arm. Then ripping it into strips. Practice doing it with your affected hand and arm doing the ripping action and then holding it still while the unaffected side does the ripping

Video 7 - Undoing and doing up zip

Sit in a chair wearing a zip up top or coat. Practice zipping up and down the top. Make sure to completely unzip and unfasten the zip each time.

Video 8 - Undoing and doing up buttons

Sit in a chair wearing a button up shirt. Practice buttoning up and buttoning down the shirt. Make sure buttons go in the correct hole.
Tip: You can vary the difficulty by using shirts with bigger or smaller buttons.

Video 9 - Using scissors

If your dominant hand has been affected. Take a pair of scissors and practice cutting paper. Start by just cutting simple strips, but make it harder by cutting out pictures and shapes to gain better control.

Video 10 Functional UL tasks – cutting up

Position yourself at a table, ensure that the plate or chopping board is secure. Using a knife and folk practice cutting up softer items such as a banana or bread and progress to cutting up tougher textures such as toast.

UL WB in standing with unaffected arm active

Standing at a flat surface place the palm and fingers of your affected hand on the surface. Complete an activity with your unaffected hand e.g. picking up coins, this will help your affect arm to act as a pivot as a strengthening and stretching exercise.

Scapula setting

There are a number of ways of doing this, but it can be quite difficult to feel what you are doing here, so you may want to do this with a top that allows someone to stand behind you and look at what your shoulder blades are doing. They need to give you feedback on whether both sides look the same. Try not to allow the shoulder blade to “wing” or stick out, more than the other side.
Sitting without back support push your fists into the chair either side of you and hold for up to 10 secs. You will feel your shoulder blades drawing down the back. 
Standing with your arms out in front of you, palms against the wall. Push into the wall and think about drawing your shoulder blades down your back. If they are poking out you are not doing it right, they should stay relatively flat to your back. 
 

Table slides abduction circular motion

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table). Move your hand in a circular motion on the table out to the side of your body. Please inform your therapist should you experience any discomfort or pain whilst performing this activity.

Table slides abduction - reaching

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table).

Slide your hand on the table out to the side away from your body. Aim for a target positioned out to the side of the table to aim for such as some coloured tape on the table or an everyday object such as a heavy book.

Try to keep your back in contact with the chair and avoid leaning forward or to the side.

Tip: You can progress this activity by moving the target further away but within an achievable reach. Please inform your therapist should you experience any discomfort or pain whilst performing this activity.

Tables slides abduction side to side

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table).

Slide your affected hand on the table out to the side and slide your hand back to your midline. Repeat as instructed by your Therapist. Should your arm become painful stop the exercises and speak to your Therapist.

Tip: Aim for a target within comfortable reach to begin with such as some coloured tape on the table or a book and extend the distance as your reach improves.

Table slides flexion – extension

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table).

Keeping your back in contact with the chair, slide your hand forward on the table. Try to straighten your elbow whilst reaching forward.

Try to avoid your hand/arm coming across the table into the middle.

Tip: Position a target such as coloured tape or an everyday object in front to reach to. You can progress this activity by moving the target further away but within an achievable reach to aim for.

Wall slides

Position yourself at a wall or door frame (ensure that surfaces are smooth to avoid snagging your skin).

You want to be within extended reach.

Place your hand flat on either the wall or door frame, running your flat hand up and down. If possible aim for targets by placing coloured tape up high and waist height. Keep your hand flat against the surface throughout.

Video 1 - UL stretch – Fingers

1st Exercise: Position yourself sitting to a table. Place your flat on the table and open your fingers out and bring them back together again.

2nd Exercise: Sitting to a table keep your wrist on your affected hand in contact with the table and place an empty plastic bottle (for example empty water bottle) near your fingers. Extend your fingers out as straight as you can, try to knock the bottle over.

Repeat as instructed by your Therapist.

Video 2 - UL stretch wrist

In sitting, interlink your fingers and gently bend your wrists back and forth to allow a gentle stretch.

Place your hand flat on the table and gently bend your wrist whilst leaning forward.

TIP: If you notice some active movement in your affected wrist position your wrist over a cylindrical object (i.e. water bottle) and left your wrist up into neutral and beyond if able. You can position a pen or straw on your wrist, hold in place with your unaffected hand and try to aim to touch the pen/straw and aim or this target

Video 3- UL WB in sitting with you unaffected mark.

Standing at a flat surface place the palm and fingers of your affected hand on the surface. Complete an activity with your unaffected hand e.g. picking up coins, this will help your affect arm to act as a pivot as a strengthening and stretching exercise.

Video 1 - Epley manoeuvre left side 1

Position yourself close to one edge of your bed sat up at a 90 degree angle. Turn your head about 45 degrees to the Left. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.

Video 2 - Epley manoeuvre left side 2

Position yourself in the middle of your bed with pillows stacked at the small of your back, sat up at a 90 degree angle. Turn your head about 45 degrees to the Left. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.
 

Video 3- Epley manoeuvre right side 1

Position yourself close to one edge of your bed sat up at a 90 degree angle. Turn your head about 45 degrees to the Right. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side but make sure your neck continues to be extended. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.

Video 4 - Epley manoeuvre right side 2

Position yourself in the middle of your bed with pillows stacked at the small of your back, sat up at a 90 degree angle. Turn your head about 45 degrees to the Right. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side but make sure your neck continues to be extended. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.

Video 5 - Gaze stabilisation with progression

Hold your finger out in front of you or place a business card/paper with X on it onto the wall in front of you at eye height. Rotate your head side to side, keeping your finger in focus.  Continue to do this as you take steps forwards, backwards, side to side or with the X placed on a busy background.

Video 6 - Gaze stabilisation

Hold your finger out in front of you or place a business card/paper with X on it onto the wall in front of you at eye height. Rotate your head side to side, keeping your finger in focus.  Continue to do this for 1 minute without stopping.

Video 7 - Substitution

Place 2 targets at eye level on a wall, approx. 1m apart.
Stand approximately 1 m away from the wall. Move your eyes to the target on your left whilst keeping your head in neutral. Then move your head to face the same target on your left. Then move your eyes to the target on your right. Once the eyes are fixed on the target, move your head to face the target on your right. Continue to repeat this exercise for up to one minute. 

Video 8 - Walking with head movements

Start walking, as you do so move your head all in all directions (Up, Down, Left and Right) without breaking stride. Try to keep your rhythm and walking pattern.

Video 9 - Walking with head turns

Start walking, as you do so move your head from left to right without breaking stride. Try to keep your rhythm and walking pattern.

Video 10 - BBQ roll