What is a varicocele?
The veins that carry blood away from the testicle form a net-like network (the pampiniform plexus) along the spermatic cord in the scrotum. Enlargement of these veins is called a varicocele. When the scrotum is checked by hand, it feels like a “bag of worms”, and in severe cases it is visible through the skin.
A varicocele usually develops during adolescence, at 10–15 years of age, and occurs in about 15% of boys. Almost 90% are on the left side, because the left testicular vein drains into the kidney vein at a right angle and the pressure there is higher.
Grades
- Grade I: can be felt by hand only when straining (holding the breath and bearing down).
- Grade II: can be felt by hand at rest but is not visible.
- Grade III: visible through the skin.
The grade alone is not a criterion for deciding on surgery. The main indicator is the growth of the testicle.
Why does it matter?
Blood pools in the enlarged veins and the temperature of the testicle rises. In some adolescents, this causes the testicle on the varicocele side to fall behind in growth and semen parameters to worsen later on. But in most adolescents with a varicocele, the testicle grows normally and no treatment is needed.
Evaluation
- examination standing and lying down,
- measuring and comparing the volume of both testicles by ultrasound,
- assessing reflux in the veins with Doppler,
- in adolescents who have completed puberty, semen analysis when needed.
When is treatment needed?
- the testicle on the varicocele side is more than 20% smaller than the other, and the difference persists on repeat measurement,
- the varicocele causes pain or a feeling of heaviness,
- a varicocele that can be felt on both sides,
- there is also another problem affecting the testicle,
- semen analysis is abnormal in a mature adolescent.
If none of these apply, the adolescent is followed with an examination and ultrasound every 6–12 months.
Treatment methods
- Microsurgical subinguinal varicocelectomy: through a small incision below the groin, the enlarged veins are tied off under a microscope while the artery and lymphatic vessels are preserved. The risk of recurrence and hydrocele is lowest.
- Laparoscopic varicocelectomy: the veins are tied off from inside the abdomen. A special dye may be used to preserve the lymphatic vessels.
- Embolization: a special material is passed into the vein from inside the blood vessel to block it.
More: varicocelectomy.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- A varicocele that appears suddenly in a young child, especially on the right side, and doesn't go away when lying down (a cause in the abdomen should be looked for)
- Sudden pain and swelling in the testicle
Note for pediatricians and family doctors
In adolescent varicocele, the main decision criterion is the difference in testicular volume: intervention is discussed when the ultrasound-measured volume difference is more than 20% (or more than 2 ml) and persists on repeat measurement. Other indications: painful varicocele, bilateral palpable varicocele, an additional condition affecting the testis, abnormal semen analysis in a mature adolescent. A varicocele that does not decrease when supine, appears suddenly, or is isolated on the right side requires abdominal ultrasound to rule out a retroperitoneal mass.
What happens at the visit?
- The adolescent is examined standing and lying down, with straining, and the grade of the varicocele is determined.
- The volume of both testicles is measured by ultrasound, and reflux in the veins is assessed.
- If surgery is not needed, a follow-up plan every 6–12 months is set.
- If surgery is needed, the methods (microsurgical, laparoscopic, embolization) are compared.
Frequently asked questions
Will a varicocele cause infertility later on?
In most cases, no. Most men with a varicocele become fathers naturally. The risk rises when the testicle starts to shrink or semen parameters become abnormal. The purpose of follow-up is to catch exactly these cases in time.
Can he play sports?
Yes. A varicocele does not limit sports. If there is discomfort after standing for a long time, supportive underwear can help.
Will the testicle grow after surgery?
In most adolescents, the smaller testicle catches up in size with the other one after surgery.
Related topics
Sources
- EAU Guidelines on Paediatric Urology, 2025: Varicocele in children and adolescents.
- Silay MS et al. Treatment of varicocele in children and adolescents: a systematic review and meta-analysis from the EAU/ESPU Guidelines Panel. Eur Urol, 2019.
This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.