A varicocele is an abnormal enlargement of the veins within the scrotum, similar to varicose veins in the legs. It is more common in adolescent boys and young men but can be detected in younger children as well. Though usually painless, a varicocele can affect testicular growth, cause scrotal discomfort, and in the long term, lead to male infertility if left untreated.
Early diagnosis and intervention from a pediatric urologist in Nagpur, like Dr. Sadashiv Bhole, can prevent long-term complications and ensure healthy reproductive development.
What is a Varicocele?
- A varicocele is a group of dilated veins in the pampiniform plexus, which drains blood from the testicles
- Most commonly occurs on the left side due to anatomical reasons
- Seen in approximately 15% of adolescent boys, and about 40% of males with infertility
Causes of Varicocele
- Weak or absent valves in the testicular veins, allowing blood to flow backward and pool
- Increased venous pressure from standing or physical activity
- Anatomical compression of the left renal vein (nutcracker syndrome in rare cases)
- Occasionally linked to growth spurts during puberty
Symptoms of Varicocele in Children and Teens
- Scrotal swelling, more prominent on standing or at the end of the day
- Dull aching pain or discomfort in the scrotum
- Feeling of heaviness or dragging sensation
- Visible or palpable “bag of worms” texture above the testicle
- Testicular size discrepancy – the affected testicle may be smaller
- Rarely, pain during physical activity or sports
Some boys may be asymptomatic, and the condition is discovered during routine examination.
Grading of Varicocele
- Grade 1: Felt only during Valsalva maneuver (bearing down)
- Grade 2: Palpable without Valsalva, not visible
- Grade 3: Clearly visible and easily palpable
Diagnosis of Varicocele
Evaluation by a pediatric urology expert includes:
- Physical examination in both standing and lying positions
- Scrotal ultrasound with Doppler to confirm diagnosis, grade the varicocele, and assess blood flow
- Testicular volume measurement to detect growth asymmetry
- Semen analysis (if age-appropriate) in older adolescents with fertility concerns
Complications of Untreated Varicocele
- Testicular growth arrest (most common in pediatric patients)
- Testicular atrophy over time
- Risk of reduced sperm count and motility in adulthood
- Increased temperature around the testicles may affect sperm production
- Psychological distress due to visible swelling or discomfort
When is Surgery Needed?
Surgery (varicocelectomy) is indicated if:
- There is significant testicular size discrepancy
- Child complains of pain, discomfort, or swelling
- There is a high-grade varicocele (Grade 2 or 3)
- Fertility preservation is a concern in older adolescents
- Family prefers correction for cosmetic or psychological reasons
Varicocele Treatment Options
Microsurgical Varicocelectomy
- Gold-standard technique
- Involves high ligation of dilated veins through a small incision
- Microscopic magnification allows precise dissection and preservation of arteries and lymphatics
- Low recurrence and minimal complications
Laparoscopic Varicocelectomy
- Minimally invasive
- Preferred in bilateral varicoceles or in obese patients
- Quick recovery and less postoperative pain
Percutaneous Embolization (less common in children)
- Done by an interventional radiologist
- Involves blocking the abnormal vein from inside
- Used in select cases or recurrences
Postoperative Care
- Minimal pain and swelling
- Child can resume school in 3–5 days
- Sports and physical activity to be avoided for 2–3 weeks
- Regular follow-up to monitor testicular growth and sperm health in adolescents
While varicocele is often silent, its impact on testicular development and future fertility should not be underestimated. With expert care and early intervention, your child can enjoy a healthy future, free from pain and reproductive risk.
If your child has scrotal swelling, discomfort, or testicular asymmetry, consult Dr. Sadashiv Bhole, Nagpur’s most trusted pediatric urologist, for comprehensive diagnosis and world-class treatment.A varicocele is an abnormal enlargement of the veins within the scrotum, similar to varicose veins in the legs. It is more common in adolescent boys and young men but can be detected in younger children as well. Though usually painless, a varicocele can affect testicular growth, cause scrotal discomfort, and in the long term, lead to male infertility if left untreated.
Early diagnosis and intervention from a pediatric urologist in Nagpur, like Dr. Sadashiv Bhole, can prevent long-term complications and ensure healthy reproductive development.
What is a Varicocele?
- A varicocele is a group of dilated veins in the pampiniform plexus, which drains blood from the testicles
- Most commonly occurs on the left side due to anatomical reasons
- Seen in approximately 15% of adolescent boys, and about 40% of males with infertility
Causes of Varicocele
- Weak or absent valves in the testicular veins, allowing blood to flow backward and pool
- Increased venous pressure from standing or physical activity
- Anatomical compression of the left renal vein (nutcracker syndrome in rare cases)
- Occasionally linked to growth spurts during puberty
Symptoms of Varicocele in Children and Teens
- Scrotal swelling, more prominent on standing or at the end of the day
- Dull aching pain or discomfort in the scrotum
- Feeling of heaviness or dragging sensation
- Visible or palpable “bag of worms” texture above the testicle
- Testicular size discrepancy – the affected testicle may be smaller
- Rarely, pain during physical activity or sports
Some boys may be asymptomatic, and the condition is discovered during routine examination.
Grading of Varicocele
- Grade 1: Felt only during Valsalva maneuver (bearing down)
- Grade 2: Palpable without Valsalva, not visible
- Grade 3: Clearly visible and easily palpable
Diagnosis of Varicocele
Evaluation by a pediatric urology expert includes:
- Physical examination in both standing and lying positions
- Scrotal ultrasound with Doppler to confirm diagnosis, grade the varicocele, and assess blood flow
- Testicular volume measurement to detect growth asymmetry
- Semen analysis (if age-appropriate) in older adolescents with fertility concerns
Complications of Untreated Varicocele
- Testicular growth arrest (most common in pediatric patients)
- Testicular atrophy over time
- Risk of reduced sperm count and motility in adulthood
- Increased temperature around the testicles may affect sperm production
- Psychological distress due to visible swelling or discomfort
When is Surgery Needed?
Surgery (varicocelectomy) is indicated if:
- There is significant testicular size discrepancy
- Child complains of pain, discomfort, or swelling
- There is a high-grade varicocele (Grade 2 or 3)
- Fertility preservation is a concern in older adolescents
- Family prefers correction for cosmetic or psychological reasons
Varicocele Treatment Options
Microsurgical Varicocelectomy
- Gold-standard technique
- Involves high ligation of dilated veins through a small incision
- Microscopic magnification allows precise dissection and preservation of arteries and lymphatics
- Low recurrence and minimal complications
Laparoscopic Varicocelectomy
- Minimally invasive
- Preferred in bilateral varicoceles or in obese patients
- Quick recovery and less postoperative pain
Percutaneous Embolization (less common in children)
- Done by an interventional radiologist
- Involves blocking the abnormal vein from inside
- Used in select cases or recurrences
Postoperative Care
- Minimal pain and swelling
- Child can resume school in 3–5 days
- Sports and physical activity to be avoided for 2–3 weeks
- Regular follow-up to monitor testicular growth and sperm health in adolescents
While varicocele is often silent, its impact on testicular development and future fertility should not be underestimated. With expert care and early intervention, your child can enjoy a healthy future, free from pain and reproductive risk.
If your child has scrotal swelling, discomfort, or testicular asymmetry, consult Dr. Sadashiv Bhole, Nagpur’s most trusted pediatric urologist, for comprehensive diagnosis and world-class treatment.
