A varicocele is a group of enlarged veins that drain the blood supply from the testicles and are generally found in the sac of skin that holds testicles in males (scrotum).
It is similar in nature to varicose veins that sometimes appear on different parts of legs. Boys are more likely to have issues with varicoceles during puberty, but they can occur earlier than that in some boys.
Causes of Varicoceles in Younger Males
Varicoceles may develop due to problems with valves within scrotal veins that control blood flow. When this happens, the resulting backup causes veins in the scrotum to become larger, or swollen. While either side of the scrotum may be affected, varicoceles tend to develop on the left side because the left testicular vein inserts into the left renal vein in a 90-degree configuration and therefore most susceptible to backflow of blood.
Symptoms & Reasons to Seek Treatment
Varicoceles are sometimes only a cosmetic issue, but other times they may affect a young male’s sperm count. Swollen scrotal veins rarely produce symptoms. In many instances, it is only when the swollen veins are seen or felt by the patient or a doctor during a routine exam that varicoceles are detected. If symptoms are present, they may include:
- Sharp or dull discomfort felt in the scrotum
- Discomfort related to physical exertion in the lower abdominal or pelvic area
- Pain that becomes noticeable when standing, especially for extended periods of time
Diagnosing & Treating Varicoceles
- A pediatrician can usually make a diagnosis during a physical examination, especially if the swollen scrotal veins can be seen or felt.
- If there is a need to rule out other sources of pain in this area, image tests may be performed. Ultrasound of the testicles and scrotum is typically the imaging modality of choice to check the size of the testicles, the varicocele, and other potential findings in the scrotum.
With varicoceles that are not producing significant symptoms, the only treatment may be regular exams to determine if the abnormal veins are getting larger or, more importantly, to see if there is any problem with growth of the testicle on the side with the varicocele.
When surgery is recommended, it can be done as an open procedure, with a microscope, or laparoscopically. These procedures involve redirecting blood flow in the affected vein(s).
Occasionally, procedures by special x-ray doctors (Interventional Radiologists) may treat the enlarged varicocele vein by blocking the affected veins with special coils or glue that causes scarring of the varicocele. This is called percutaneous embolization.