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Varicoceles

A varicocele is an excessive widening of the vein that drains blood from a testicle. It acts like a varicose vein of the scrotum. Varicoceles are similar to varicose veins in more familiar sites like the legs in that faulty valves allow blood to pool inside the vein. Over time, the vein enlarges — sometimes dramatically — to accommodate the extra blood.

It is estimated that up to 25% of teens and young men have a varicocele, but milder cases might never be diagnosed, especially if they do not cause any pain or discomfort. Varicoceles are most commonly diagnosed during the mid-late teen years or in early adulthood. About 90% occur in the left testis since that vein’s return route to the heart is more complicated than the right side’s.

Diagnosis & Treatment

Symptoms

Because varicoceles typically develop during adolescence, your son will be the first to notice if he has one.

Symptoms may include:

  • A painless sac near the left testicle
  • Visibly enlarged vein in the scrotum, including a “bag of worms” effect
  • Dragging or aching pain in the scrotum
  • Feeling of heaviness in the testis
  • Shrinking of the affected testis

Your son may be reluctant to show you his varicocele or discuss it with you. We encourage parents to keep the lines of communication open about physical and emotional health with their children at all ages. In this case, the message should be to let you or a healthcare provider know promptly about visual changes or discomfort in any part of their bodies, especially their genitalia.

Diagnosis

Diagnosis typically involves only a physical exam, allowing us to assess your son’s varicocele by severity and recommend appropriate treatment:

  • Grade I – The varicocele can be felt only when straining as if to have a bowel movement
  • Grade II – The varicocele can be felt even without straining
  • Grade III – The varicocele can be seen

For Grade III varicoceles, we may request imaging to compare the relative size of the left and right testes, as that is an important indicator of whether the varicocele is likely to cause infertility later in life.

Treatment

We will work with you and your son to develop a treatment plan that best fits his needs, based on the specifics of his condition. As a parent, your treatment decision-making process will likely focus on your son’s future fertility. Varicoceles are known to be a major cause of infertility in adult males. About 40% of men diagnosed with infertility are found to have a varicocele. However, repairing the varicocele, whether in adolescence or adulthood, often leads to normal fertility.

If your son is not uncomfortable, you may decide not to treat the varicocele at this time. In this case, we recommend that your son is examined once a year to check that the testis on the affected side remains the same size as the unaffected testis. If the testis is starting to shrink, or atrophy, that increases the chances your son will become infertile as an adult and we will most likely recommend surgical repair.

With our specialists, you have a choice of either laparoscopic or open-field microsurgery. Both types of surgery are performed on an outpatient basis. The laparascopic approach takes about 45 minutes, while open-field microsurgery usually takes about 90 minutes. Postoperative pain and recovery times are similar with both techniques. Usually, ice packs, over-the-counter pain relievers and several days away from gym class are all that is needed.

Make an Appointment

If you’d like to request an appointment with one of our specialists from the Division of Urology, call 1.800.KIDS DOC® or request an appointment online.

 
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Related Specialties & Services

Read about the specialty areas and services that treat Varicoceles.