By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SON’S VARICOCELE SHOULD PROMPT EVALUATION OF TESTICULAR GROWTH

Question: When my son had his high school sports physical, he was told he had a varicocele, but not to worry about it. Of course, I am concerned. Exactly what is this? Can it cause problems, like cancer? Does it need to be treated?

Answer: A varicocele occurs when varicose veins develop in the scrotum along the spermatic cord. About 15 percent of males between the ages of 15 and 25 experience this condition. A varicocele develops because the testicles grow rapidly during puberty, and the veins in that area are not able to handle the increased blood flow. Veins have valves in them to keep the blood flowing in the right direction. The increased blood volume can cause the valves to fail, allowing blood to back up and lead to swelling, or dilation, in the veins. This is the same as the development of varicose veins in your legs -- failure of the vein valves. Varicoceles are more common on the left side, and seldom occur on both sides.

Usually there are no symptoms of this problem, and it is commonly found on a routine physical, as with your son. Some people can have some dull aching in the scrotum with prolonged standing or sitting. The testicle on the affected side is often smaller than the non-affected side.

While many men with a varicocele do not have fertility problems, it is one of the most common causes of male infertility. In fact, about 30 percent of infertile men have a varicocele. Most cases of varicocele require no treatment. However, when a man has fertility problems or chronic discomfort attributable to the varicocele, various treatment options are available.

Varicoceles may be managed with a scrotal support. If this is insufficient, other possible treatments include open surgical removal, laparoscopic removal, and catheter embolization.

Both open and laparoscopic varicocelectomy -- the surgical correction of a varicocele -- are performed on an outpatient basis. The cut is usually made in the lower abdomen, although various techniques can be used. Ice packs should be kept to the area for the first 24 hours after surgery to reduce swelling. In catheter ablation -- also done as an outpatient procedure -- a small puncture is made at the crease where the leg joins the body.

After surgery, the patient will be advised to use ice and to wear a scrotal support. Possible complications include blood clot formation, infection or injury to the scrotal tissue or structures. In addition, injury to the artery that supplies the testicle may occur.

Your son may need additional evaluation to determine if his testicular growth is normal. The American Urological Association says that “Adolescents who have a varicocele and objective evidence of reduced testicular size [on that same side] should be offered varicocele repair.” Also, in a young man, persistent or frequent pain in the testicle should be evaluated.

If a varicocele develops suddenly in an older man, it should be promptly evaluated as it can signal major medical problems. To date, there has been no correlation established between having a varicocele and the development of testicular cancer. All that being said, most men do not require this surgery and learn to live with the problem.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.