Paediatric Urology – Varicocele

W hen the veins around the testicle enlarges, it is referred to as a varicocele (basically a varicose vein in the area of the testicle).

It usually causes no symptoms and often does not require treatment. Large varicoceles can cause infertility in men but not all men with varicoceles are infertile. Varicoceles are most common in males aged 15 to 25 years. It is rare for an older man to develop a varicocele.

1What causes a varicocele?

A varicocele is the result of dysfunction of veins that carry blood from the scrotum to the heart. Normal veins have valves that prevent the backflow of blood towards the scrotum. In a patient with a varicocele, dysfunction of these valves leads to inadequate drainage of blood from the testicular veins.
In very rare circumstances, the backflow of blood in the testicular veins may be as a result of a tumor in the abdomen compressing the veins. This rare type of varicocele (caused by tumor) is mostly seen in men older than 40 years.

2What tests can be done to diagnose a varicocele?

  • Clinical examination:
    Most varicoceles are diagnosed on clinical examination. Your doctor will examine your scrotum and the surrounding structures.
  • Ultrasound:
    An ultrasound of the scrotum can be done to confirm the presence of a varicocele. Ultrasound is also useful to pick up a possible tumor in the abdomen of an older man who develops a varicocele.
  • Semen analysis:
    This can be done to assess the quality and number of sperms produced by the testicles. Because some varicoceles can cause infertility, a semen analysis is useful in a man who has a varicocele and who has fertility problems.

3What are the complications of a varicocele?

  • Pain and discomfort in the scrotum and testicles.
  • Male infertility.
  • A decrease in the size of the testicle.

4What are the options for treatment of a varicocele?

1. Conservative treatment:
Most varicoceles do not require any treatment. For men who have only mild discomfort from time to time, tight fitting underpants can give scrotal support and prevent the discomfort associated with the engorgement of the enlarged testicular veins.

2.Varicocele surgery:
Surgery is needed only in cases where the varicocele causes severe complications (persistent pain, infertility, shrinkage of the testicle).
There are various surgical options for dealing with a varicocele:

  • Varicocelectomy involves tying off the veins that are enlarged to prevent backflow of blood into the scrotum. This can be done via an incision on the abdomen or the scrotum.
  • Sclerotherapy involves injecting a chemical substance into the enlarged veins in order to block them and thus to prevent backflow of blood.