Varicocele

What is a varicocele?

A varicocele is mass of enlarged and swollen veins in the testicle that essentially feels like a bag of worms. The condition usually develops at puberty, but can occur earlier and is generally neither harmful nor painful. Approximately 15 percent of boys have this condition, which almost always occurs on the left side.

What causes a varicocele?

There are several theories as to what causes varicoceles, however, none have been conclusively proven.

Is a varicocele harmful to my son?

Probably not. However, some varicoceles can inhibit growth of the testicle, and are found in four out of 10 men with infertility problems, making them the most common reversible cause of male infertility. The relationship between the size of the varicocele and the potential risk for infertility is unclear.

How is a varicocele diagnosed?

Only occasionally does an adolescent with a varicocele experience any pain or discomfort. Therefore, the condition is usually discovered during a routine physical examinations or incidentally while bathing, when the large veins can be easily seen and felt.

Once it's detected, your son will be referred to a pediatric urologic specialist who will do a comprehensive evaluation of the condition that includes:

  • a complete health history
  • physical examination
  • scrotal/testicular ultrasound

We have found that the testicular ultrasound is the best test to compare the size of the testicles. Based on this assessment, your pediatric urologist will discuss options and recommend the best course of therapy.

How are varicoceles treated?

If there's no pain, your urologist may recommend doing nothing but coming back annually for ultrasounds to be sure the varicocele isn't hindering proper growth of the testicle. Varicoceles sometimes impair testicular growth, resulting in a smaller testicle. There is a definite relationship between the size of the varicocele and the volume or size of the testicle.

If your son is experiencing pain, your doctor will probably recommend a simple surgical procedure, performed routinely under anesthesia on an outpatient basis. During this procedure, called a varicocelectomy, doctors make a small incision and remove only the veins that are causing the problem. Your pediatric urologist will discuss with you whether this is a viable option for your son.

How we care for varicoceles

Boston Children's Hospital physicians make a diagnosis based on whether your son is having any pain associated with the varicocele. If your son is experiencing pain, your urologist will recommend a simple, outpatient surgical procedure. If there's no pain, your urologist may recommend nothing more than annual ultrasounds to ensure your son's testicle is growing normally. A current study is examining which approach is better in adolescents: immediate surgery for the varicocele, or with the option of surgery after a waiting period.