Varicocele in children

Varicocele in children occurs when the veins in the scrotum (around the testes) enlarge and swell. Similarly to varicose veins, this condition can cause discomfort and sometimes affect testicular growth.  

At our private children’s urology service, we provide dedicated paediatric support and treatment to manage your child’s symptoms effectively.  

What is varicocele in children? 

Varicoceles are swollen (dilated) veins in the scrotum. 

They occur when the spermatic cord – a group of tubes and blood vessels that help carry sperm, blood and messages to and from the testicles – doesn’t work correctly.   

Usually, the veins within this cord take the blood back towards the heart. Tiny valves help to ensure blood flows in the right direction. However, if these valves don’t close properly, blood can pool inside the veins. As this blood builds up, it can cause the veins to dilate. 

Generally, a varicocele develops in the left testicle because of the angle at which blood flows from the scrotum into the kidney veins. This development may lead to pressure build-up in your child’s scrotum and dilate the veins. 

Who is at risk of varicocele? 

Varicocele may be more common in boys going through puberty than younger boys. Teenage boys grow quickly, increasing the flow of blood to the testicles. 

If their veins cannot move this additional blood effectively, it can lead to varicocele.   

Types of varicocele in children 

There are 3 gradings for varicocele in children:  

• grade I – varicocele is only felt when your child exerts or strains 
• grade II – varicocele is felt at rest but is not visible 
• grade III – varicocele is clearly visible during a physical exam 

Symptoms of varicocele in children 

Most boys with varicoceles do not experience any symptoms.  

However, when symptoms do occur, they may include:  

• a chronic dull ache in the scrotum 
• having one testicle smaller than the other 
• being able to feel swollen blood vessels in the scrotum 
• a heavy feeling in the scrotum that worsens after activity 

It’s essential to remember that your child might not describe their symptoms like this.  

Pay close attention to how they act after playing or exercising and whether they mention any pain or discomfort in their scrotum or the general area.   

What causes varicocele in children? 

The exact cause is not clearly understood but the main issue leading to varicocele in children is problems with the valves in their scrotal veins. Sometimes, problems with groin anatomy can also cause varicocele in children. In rare cases, swollen lymph nodes or an abdominal mass can prevent blood from flowing to the veins in the scrotum.  

Complications of varicocele 

Most children with varicocele are asymptomatic without any consequences. In some cases, varicocele can cause pain, swelling, discomfort or a dragging sensation in the scrotum. In some children, it can affect the testicular growth, leading to smaller testes and, in some children, there is a risk that the condition may affect fertility during adulthood.  

Diagnosing varicocele in children 

To diagnose varicocele in children, we perform a physical examination first. We’ll check their scrotum for any signs of varicocele. We’ll also ask about their symptoms and medical history. Often, a physical exam is all our specialists need in order to diagnose varicocele. 

An ultrasound (a painless imaging scan) is performed to closely examine the size of dilated vein in the varicocele and accurately measure testicular size. This helps to determine the severity, effect and best course of treatment for your child. 

Treatment for varicocele in children 

Often, varicocele in children does not require treatment. However, your consultant may advise regular health check-ups to monitor any changes.  

We may recommend surgery if:  

• their testicle is showing a delayed development as a result of varicocele 
• they’re experiencing pain and discomfort  

Varicocele surgery 

Varicocele surgery aims to close the affected vein in your child’s scrotum to help redirect blood back towards healthier veins. This treatment is usually performed under general anaesthetic to help keep your child still and safe throughout the procedure.  

There are 3 options to treat varicocele. Your consultant will discuss these options with you to determine which is most suitable for your child:  

• laparoscopic varicocelectomy – this minimally invasive surgery uses a thin tool with a camera on one end called a laparoscope, with multiple small incisions made in the abdomen. The surgeon feeds the laparoscope through one incision and surgical tools into the other incisions, enabling them to tie or cut off the swollen veins along the back wall of your child’s abdominal cavity. 
• varicocele embolisation – this procedure uses X-ray guidance to treat enlarged veins in the scrotum. A small cannula is inserted into a vein in the groin or neck and a catheter is passed through it to reach the testicular vein. This confirms its position and tiny coils or foam are inserted into the vein to block blood flow. 
• microscopic varicocelectomy – the surgeon makes a tiny incision above the scrotum and uses a specialised microscope to see the veins that need treatment. The surgeon then ties off the dilated veins.

After the treatment is complete, we’ll take your child to the recovery area where we’ll monitor them as they come round from the anaesthetic. Most of the time, your child can go home with you on the same day. 

We’ll keep you informed every step of the way so you can feel confident that your child is receiving the best, most specialised care possible. 

Helping your child recover at home 

We’ll provide personalised recovery advice so you can support your child’s recovery at home. Your child will most likely feel some discomfort and bloating when they return home, so make sure you have the correct pain relief medication, as advised by their surgeon, to help with this. 

If you have any questions about your child’s recovery, do not hesitate to contact us; we’ll be happy to answer them.