A varicocele is a group of swollen veins around the testicle. It is similar to having varicose veins in the legs. Varicoceles are common in teenagers and are usually found on the left side.
Many varicoceles do not cause problems. Some children may have a dull ache or heaviness in the scrotum. A varicocele can also cause one testicle to grow more slowly than the other.
Your child may not need treatment right away. The health-care team may watch the varicocele and check the size and growth of the testicles over time. Surgery may be considered if the testicle is not growing normally, there is ongoing pain, or there are other concerns.
Varicocelectomy surgery
A varicocelectomy is surgery to treat a varicocele. During surgery, the surgeon closes off the enlarged veins that are causing the varicocele, often using small surgical clips, sutures or cauterization to seal the veins.
The procedure may be performed using a microscope or other surgical techniques to identify and preserve important structures, such as the testicular artery and lymphatic vessels. Blood can then return through other healthy veins
Laparoscopic surgery
Laparoscopic surgery is a way to perform operations using only very small incisions (cuts) into the skin. This surgery uses a thin rod-shaped instrument with a tiny camera on the tip, called a laparoscope. The laparoscope is put into the body and moved from the outside by the surgeon. The camera sends pictures to a screen. During the operation, the surgeon can see the organs inside the body on the screen.
Because this surgical technique does not require a big incision like traditional open surgery does, laparoscopy is often referred to as minimally invasive surgery.
Laparoscopic surgery generally follows these steps:
- The surgeon makes a few small cuts in the belly.
- A laparoscope is placed through one of the cuts.
- Small tools are then inserted through the other cuts.
- The surgeon uses the laparoscope and tools to find and close the veins that cause the varicocele. The laparoscope gives the surgeon a close-up view of the blood vessels.
- The tools are removed and the surgeon closes the small cuts
Laparoscopic surgery can also be useful when both sides need to be treated because both sides can be reached during the same operation.
Robotic surgery
Robotic surgery is a type of laparoscopic surgery.
The surgeon controls small robotic instruments from a nearby console. The robot does not perform the surgery by itself.
The robotic system can give the surgeon a magnified view and allow very small movements of the surgical instruments.
Your child's surgeon can explain why a particular type of surgery is being recommended and the devices that may be used to complete the procedure (e.g., clips versus sutures).
All surgeries have risks. Your child's surgeon and anesthesia team will explain the risks for your child.
Possible risks include:
- pain
- bleeding
- infection
- swelling or bruising
- problems with urination for a short time
- a varicocele that comes back
- a hydrocele, which is a collection of fluid around the testicle
- injury to nearby blood vessels or nerves
- injury to other nearby structures
- problems related to anesthesia
- damage to the blood supply of the testicle
Before surgery, your child will usually have a clinic visit with the surgical and anesthesia teams. During this clinical visit, the teams will:
- review your child's medical history
- check medicines and allergies
- examine the testicles
- review any ultrasound or other tests
- talk about general anesthesia
- explain what will happen on the day of surgery
- give instructions about when your child can eat and drink
Talk to the surgical team about
Eating and drinking
Your child will need to stop eating and drinking for a certain amount of time before anesthesia.
Follow the instructions from your hospital exactly. The instructions may be different depending on your child's age and the type of anesthesia.
If your child eats or drinks when they were told not to, tell the surgical team. The surgery may need to be delayed for safety.
Medications
Tell the team about all prescription medicines, over-the-counter medicines, vitamins and supplements your child is taking.
Discuss which medications can be given or should not be given before the surgery or need to be stopped in the days leading up to the surgery.
Illness
Tell the surgical team if your child develops:
- a fever
- a cough or cold
- trouble breathing
- another illness
- a change in their usual health
Surgery may need to be delayed if a child is sick.
For more information on preparing for surgery and what to expect on the day of the surgery, please see Coming for Surgery.
Your child will receive general anesthesia. This means your child will be completely asleep and will not feel any pain or remember the surgery.
The anesthesia team will monitor your child’s:
- heart rate
- blood pressure
- breathing
- oxygen level
- other vital signs
What happens to the blood after the veins are closed?
The testicle has more than one pathway for blood to leave it. After the enlarged veins are closed, blood can travel through other healthy veins.
Will the varicocele disappear right away?
Not always. The enlarged veins may take time to become smaller. The doctor may continue to feel or see some veins for a while after surgery.
Can the varicocele come back?
Yes, a varicocele can come back if some veins remain open or if other small veins become enlarged.
Will surgery improve fertility?
Varicoceles can affect testicular growth and may affect sperm development. Treatment may improve testicular size and some sperm measurements.
However, long-term research in children is limited. It is not known for certain whether treating a childhood varicocele improves the chance of having children later in life.
After the operation
When your child goes to the Post-Anesthetic Care Unit from the operating room, they will have an intravenous line (IV). An IV is a tiny plastic tube that is placed in a vein in the hand or arm.
Your child may be sleepy or tired for the rest of the day because of the anesthesia.
Your child may have:
- mild belly or groin pain
- abdominal bloating or feeling full
- bruising around the small cuts
- mild swelling
- shoulder discomfort for a short time from the gas used during laparoscopy
- a sore throat from the breathing tube
Most children can go home the same day after laparoscopic or robotic varicocelectomy if they are awake, comfortable, able to drink and otherwise doing well.
Pain
Your child will be started on routine pain medications after the procedure. They will be initially given through the IV line and will later be taken by mouth. The health care team will tell you how which medications to continue to manage pain at home. Always take medications exactly as prescribed.
Eating and drinking
Your child may start with fluids and then slowly resume their regular diet.
Caring for the incisions
Your child’s incision will be closed with stitches and surgical glue (Dermabond). The incision is the place where the surgeon cuts through the skin to operate. The stitches and surgical glue will start to dissolve about 10 to 14 days after the surgery. It is important not to remove the surgical glue; let it peel off on its own.
The incision and the stitches may be covered with a dressing. This will be changed by your child’s nurse while your child is in the hospital.
Keep the surgical incisions as clean and dry as possible.
Resume bathing or showers based on the instruction of your child’s health-care team.
Activity
Your child will need to avoid strenuous activity while they heal.
Most children can resume normal physical activity about two weeks after surgery, though some surgeons may recommend a longer period. The exact amount of time depends on the surgeon and the type of surgery.
Follow your child's surgeon's instructions, especially about:
- sports (especially contact sports) - do not return to sports until the surgical team says it is safe
- gym class
- heavy lifting
- running
- biking
- swimming
Complications of a varicocelectomy
Most children recover well, but complications can happen.
Hydrocele
A hydrocele is extra fluid around the testicle. It can cause swelling in the scrotum. A hydrocele is one of the most common complications reported after varicocele surgery. Minor hydroceles should self-resolve without any intervention.
Recurrent varicocele
Sometimes the varicocele comes back.
Your child's doctor will check for this during follow-up visits.
Infection
An infection to the surgery site may look like:
- increasing redness
- increasing warmth
- green/yellow colored drainage or “pus”
- fever above 38 degrees Celsius
- increasing pain or pain that is unmanaged by prescribed medications
Bleeding
A small amount of bruising can be normal. Increasing swelling or bleeding is not normal and should be checked.
Testicular problems
Rarely, damage to the blood supply of the testicle can occur. This will be assessed in your child’s follow-up appointment after surgery.
It is normal for children and teenagers to feel nervous about surgery. To find strategies to help you prepare your child for surgery, please see the article “How to talk to your child about surgery”.
Older children and teenagers should be included in conversations about their care. Give them privacy when appropriate and allow them to ask questions directly to the health-care team.
A Child Life Specialist can also help to prepare and support your child if they are anxious about the operation.
Your child will have a follow-up visit with the urology team after surgery.
At follow-up, the doctor may:
- check the surgical cuts
- ask about pain
- examine the scrotum
- check whether the varicocele is still present
- compare the size of both testicles
- check for a hydrocele
- check that the testicle is continuing to grow normally
An ultrasound may be used when the doctor needs more information.
The timing of follow-up is different for each child. Some surgeons schedule a visit several weeks after surgery, while others may arrange a later visit to check testicular growth.
Long-term follow-up is important because your child's testicles are still growing during puberty.
Contact your child's health-care team if your child has:
- a fever greater than 38 degrees Celsius
- pain that is getting worse instead of better
- increasing swelling
- increasing redness around an incision
- pus or unusual drainage from the incision
- bleeding from an incision
- trouble urinating
- vomiting that does not stop
- a new or worsening swelling of the scrotum
- or if there is any concern that your child is not recovering as expected
Go to the nearest Emergency Department if your child has:
- severe or sudden testicular pain
- severe swelling of the testicle or scrotum
- heavy bleeding that does not stop
- trouble breathing
- severe weakness, fainting or difficulty waking
- severe pain that is not controlled by the prescribed medicine
- signs of a serious allergic reaction
Call 911 for a life-threatening emergency.
Children's Hospital of Philadelphia (CHOP) varicocele, pediatric urology, and information about preparing children for surgery: https://www.chop.edu/conditions-diseases/varicocele
- Silay MS, Hoen L, Quadackaers J, et al. Treatment of varicocele in children and adolescents: A systematic review and meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. European Urology. 2019;75(3):448-461.
- Barroso U Jr, Andrade DM, Novaes H, Netto JMB, Andrade J. Surgical treatment of varicocele in children with open and laparoscopic Palomo technique: A systematic review of the literature. Journal of Urology. 2009;181(6):2724-2728.
- Borruto FA, Impellizzeri P, Antonuccio P, et al. Laparoscopic vs open varicocelectomy in children and adolescents: Review of the recent literature and meta-analysis. Journal of Pediatric Surgery. 2010;45(12):2464-2469.
- Reinhardt S, Thorup J, Joergensen PH, Fode M. Robot-assisted laparoscopic varicocelectomy in a pediatric population. Pediatric Surgery International. 2023;39:202.
- Recent systematic review: Outcome following the surgical management of varicocele in children and adolescents: A systematic review and meta-analysis. Therapeutic Advances in Urology. 2023;15.