What is a varicocele?

A varicocele is mass of enlarged and dilated veins in the testicle that essentially feels like a bag of worms. It is generally not harmful and usually not painful. Approximately 15 percent of males have this condition which almost always occurs on the left side. A varicocele usually develops at puberty (age 15) but can occur earlier.

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

In older adult males, varicoceles have been associated with decreased fertility, but this occurs in a minority of patients with varicoceles. The relationship between the size of the varicocele and the potential risk for infertility is unclear.

How is a varicocele diagnosed?

Only occassionally does an adolescent with a variocele 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, an adolescent should be referred to a pediatric urologic specialist who will do a complete evaluation of the condition that includes a complete health history, physical examination and a 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.

Treatment Options
In many cases, if your child isn't experiencing any pain or discomfort, the urologist will recommend doing nothing but coming back annually for ultrasounds to be sure the varicocele isn't hindering proper growth of the testicle. Varicoceles can create an abnormal environment for testicular growth resulting in a smaller testis on the affected side. There is a definite relationship between the size of the varicocele and the volume or size of the testis.

If on the other hand, your child is experiencing discomfort of any kind, your doctor will probably recommend a simple surgical procedure, performed routinely on an outpatient basis, called a varicocelectomy. Adult men who are having problems with fertility may also opt for this surgery. During this procedure, anesthesia is administered and doctors make a small skin incision and remove only the veins that are causing the problem. Discuss with your pediatric urologist whether this is a viable option for your son.