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Varicocele

What is a varicocele?

A varicocele is a cluster of dilated veins located next to the testicle, which feels like a bag of worms. Varicoceles are quite common (15-20% of adult males) and occur mainly on the left side. They often first become apparent during puberty, but can occur earlier. Varicoceles are sometimes associated with decreased or impaired fertility (ability to have children). This is poorly understood because many males with varicoceles have no problems with fertility.

What are the symptoms?

Most children will not complain of any symptoms. One might not even be aware that they have a varicocele. However, if there are symptoms, they tend to occur, after heavy exercise, or after standing or sitting for a long period of time. Signs may include:

  • Dull ache in the testicles
  • Feeling of heaviness or dragging in the scrotum

Physical findings may include:

  • Dilated veins in the scrotum that can be felt (described as bag of worms)
  • Testicle is smaller on the side where the dilated veins are

How is a varicocele diagnosed?

A varicocele is most often detected through physical exam or by the patient himself. There is rarely pain associated with this, so an abnormal mass next to the testicle is the most common finding.

Once the varicocele is found, a scrotal/testicular ultrasound may be ordered to assess the size of the testicles and the extent of the varicocele. The doctor may also ask for a semen analysis to be performed, in the older child, to help determine if fertility might be impaired.

What is the treatment?

The treatment for varicocele varies depending on the patient and the symptoms. If the child is not having any symptoms, the testicles may be evaluated on a yearly basis to ensure adequate growth of the testicles. If growth is adequate, observation would continue and surgery be unnecessary.

If your child is experiencing pain, the testicle is not growing adequately, or if the semen analysis is abnormal, surgical repair of the varicocele may be warranted. The procedure to correct this is called a varicocelectomy. The procedure is performed in the operating room, while the child is asleep under general anesthesia. The procedure may be performed laparoscopically or via a small incision is made in the groin and the vessels that are causing the problem are tied off.