The Condition

A varicocele occurs when the veins that drain the testes enlarge, resulting in delayed drainage. This gives the appearance of a “bag of worms”, and mainly affects the left side of the scrotum. Think of it as being similar to varicose veins in the legs.

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  Varicocele appearance

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  Enlarged veins

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  Normal veins

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  Normal anatomy

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  Varicocele anatomy

The veins of the left testicle drains differently to the right, so it has a higher pressure to drain. With increased pressure, it can get to the point of enlarging as it doesn’t drain as effectively. 

Not always. If it causes pain, then it can be treated.

There is some thought about adults and an association with fertility issues, but it is not definite. 

No

Treatment

A varicocele can be corrected in a number of ways. In adolescents, there are surgical options, or with interventional radiology. Your surgeon will discuss further with you. 

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  Normal anatomy

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  Varicocele anatomy

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  Clipping vessels

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  Laparoscopy

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  Embolisation

The operation takes about 15-20 minutes.

The anaesthetic can take about the same time before and after, so you’ll be away from your child for an hour or so, until they are ready for you in the recovery room. You will be notified when they are ready for you to see them in recovery.

Talk to your surgeon about the options. It can be difficult to choose, and really depends how problematic it is. 

The anaesthetic –  airway and breathing issues are extremely rare.

Laparoscopic approach

• Recurrence 
• Injury to internal abdominal / scrotal structures 
• Infection / bleeding / bruising of the wounds in the abdomen
• Hydrocele – 15%. This is a swelling of the scrotum, and may require another operation. 

Interventional radiology embolisation

• Wound issues – usually minor
• Recurrence
• Pain – usually settles
• Coil displacement

Recovery

Recovery – you will be called into the recovery room just after they are awake.

Feeding – They can feed when hungry

Home – usually after an hour or 2, once the nursing team have ensured your child is safe and comfortable

For laparoscopic procedures there are wounds in the abdomen, which have dissolvable sutures, and a waterproof dressing, which can be removed after a week. 

Your child will receive good pain relief in the operating room, that will last a few hours. 

After the operation they will need paracetamol and possibly ibuprofen (eg. Nurofen) for a few days. Please let your surgeon and anaesthetist know if your child has intolerances or allergies. 

In order to avoid medication, aim to distract your child and keep their mind off the area. Reading, writing, playing board games and other engaging activities help. 

Bath / shower – the day after the operation

Swimming – 1 week

Daycare / School – 5-7 days

Sports – 2-3 weeks

Troubleshooting

It is uncommon for significant pain that is not controlled with simple pain killers like paracetamol and nurofen. Call your surgeon or the day unit for further advice. 

Infections can develop around 2-4 days after the operation, and is a fairly uncommon issue. 

The wound may be infected if there is increasing redness around the wound and tenderness. This may be associated with discharge from the wound site. 

You will need to see your family doctor or call your surgeon for further advice. 

It does become swollen after the operation, usually for a few days. 

If your child has increasing pain, tenderness and vomiting associated with a similar bulge to before the operation there may be recurrence. If your child is unwell, you may need to go to the emergency department. Call your surgeon and let them know. 

Otherwise see your GP and call your surgeon so your child can be assessed. 

You know your child best. If you have any concerns please see your family doctor or call your surgeon. The list below are issues that require medical attention. 

• Increasing pain or persisting pain despite pain relief
• Increasing swelling or bulge – possible recurrence
• Fever >38.2 degrees Celsius
• Vomiting and feed intolerance
• Discharge or bleeding from the wound
• No bowel motions after 3 days