A varicocele is a mass of swollen blood vessels in the spermatic cord – the structure in the scrotum that connects the testicles to the body. Varicoceles occur when veins that are supposed to carry blood away from the testicles malfunction, causing the blood to pool and enlarge the vessels. Varicoceles are generally harmless and painless and do not require treatment.
However, because sperm are produced in the testicles, in some cases, physicians will recommend surgery if it appears the varicocele will impact testicle growth and future fertility. Most varicoceles (85%) do not cause any damage or require treatment.
Varicoceles are common, and about 15% of adolescent boys and young men have them. Varicoceles typically develop during puberty, when the growth spurt and hormonal changes boost the blood flow to the testes. If the veins have any deformities or missing valves, they may not be able to handle the increase in blood, and become enlarged.
Varicoceles usually don’t cause pain and can’t be seen. Sometimes, boys may have some discomfort or experience a persistent dull ache or dragging sensation after long period of standing or exercising. Because of the restricted blood flow, varicoceles can also cause a significant difference in the size and growth of either or both testicles. In some studies, varicoceles seem to impact the overall health of sperm, and may be a factor in male infertility.
Most varicoceles are so small, they are only found during routine examinations by a pediatrician. If the veins in the scrotum are enlarged enough, they can be seen and felt. Varicoceles are most often diagnosed during puberty because that is when the blood flow to the testicles increases.
If a varicocele can be seen and felt upon examination, then a pediatrician will typically order an ultrasound of the scrotum to determine the risk of damage to the testicles. The ultrasound will help physicians measure and compare the amount of blood flow to the right and left testicles. If there is a significant impact on the blood flow to one or both testicles, or the person is experiencing pain, surgical treatment is recommended.
The main goal of surgery is to stop the blood from gathering in the veins and impacting the growth and function of the testicles. In adolescents, this surgery is typically done using laparoscopic (minimally invasive) methods to fix the veins and help normalize blood flow.
A referral to a Pediatric Urologist is recommended if a varicocele is can be seen and felt during an exam, or if your child is experiencing ongoing pain.
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