A Comprehensive Guide to Varicocele Treatment for Kids

A] What is Varicocele?

Varicocele is a medical condition where the veins inside the spermatic cord swell. It is similar to the condition of varicose veins that occurs in the legs. It is commonly diagnosed in teenage boys and is treatable. It tends to occur on the left side of the scrotum due to the differences in how blood drains from the left testicle back into the major veins of the body. Although uncommon, it can occur on the right side or both sides. 

B] Causes of Varicocele

Varicoceles is a condition in children, that becomes noticeable during puberty. It is essentially characterised by the abnormal enlargement of veins in the scrotum. Normally, the valves in these veins regulate the blood flow toward the heart; however, when the valves malfunction, the blood flows backward and accumulates, resulting in the enlargement of the veins. During puberty, the testicles experience rapid growth, and the body’s demand for increased blood flow rises. But due to weaker valves and poor circulation, a varicocele can develop.

C] Symptoms of Varicocele

Most boys don’t show any varicocele symptoms; however, when they do occur, they may include:

• Visible enlarged veins, which may feel like a bag of worms in the scrotum, especially when standing.
• Difference in the testicular size. Often, the left may appear smaller than the right.
• Pain that may worsen with prolonged standing and get better when lying down.
•  Although uncommon in children, increased warmth in the scrotum may be experienced due to blood pooling in dilated veins.

The symptoms may resemble other health conditions. Make sure to seek professional medical guidance to ensure accurate diagnosis and treatment.

D] Treatment Options for Varicocele

• Observation and Supportive Measures
  In many cases, especially among teenagers or young adults, varicocele treatment without surgery is an option. However, the right observation and care are crucial. Healthcare providers often consider observing and providing supportive measures, like annual check-ups, to monitor the condition. Factors such as no testicular asymmetry, where both testicles are about the same size; if pain, discomfort, and other symptoms are absent; and if the condition is non-progressive, i.e., testicular growth is progressing normally, in these cases, the condition can be managed without surgery.

The supportive measures may also include ultrasound imaging to keep track of the testicles’ size over time, wearing snug supportive underwear to avoid discomfort, and occasional over-the-counter pain relievers like ibuprofen, under paediatric guidance. Fertility counselling in older children or teens may also be considered if the condition is likely to persist into adulthood.

• Surgical Treatment (Varicocelectomy)

A varicocele can often be managed without surgery, especially for teenagers or young adults who are not seeking fertility treatment. However, a healthcare provider might recommend surgery if there is testicular atrophy (a difference in the size of the testicles), persistent scrotal pain, or a visible varicocele vein that causes physical discomfort.

It is important to note that varicocele surgery is not solely performed to treat pain; however, if it is done for this reason, there is a risk that the pain may worsen.

The surgery involves identifying the enlarged veins in the scrotum, which are then ligated or sealed to allow the natural flow of blood through healthy veins.

The two common approaches are microscopic varicocelectomy and laparoscopic varicocelectomy, and, in some cases, robotic laparoscopic surgery, all of which involve general anaesthesia.

The microscopic varicocelectomy is a precise and minimally invasive procedure, especially for older children and teens. It involves the use of a surgical microscope to make a small incision in the groin area. The dilated veins are then identified and carefully ligated.

Laparoscopic varicocelectomy is also a minimally invasive technique. The procedure involves the insertion of a thin video camera and surgical instruments through small incisions made in the lower abdomen. The surgeon identifies the affected area on the screen, identifies the affected veins, and ligates them to restore proper blood flow.

Both microscopic and laparoscopic varicocelectomy are outpatient procedures, which means patients are allowed to go home the same day.

• Alternative Treatment (Embolisation)

A doctor specialising in imaging (radiologist) performs this minimally invasive, non-surgical procedure. It involves inserting a small tube into a vein in the groin or neck. The radiologist, using imaging on a monitor, guides the tube to the affected site and releases coils or a solution that creates a blockage by scarring in the testicular veins. The procedure takes about an hour, and the recovery time is usually short.

E] What Care Is Needed Before and After the Surgery?

The care before varicocele surgery in children comprises medical evaluation, including a physical exam to confirm the diagnosis. This phase may also include a discussion with the doctor to understand the recommended type of surgery, whether microsurgical or laparoscopic.

Preoperative instructions are also among the important steps that include fasting, usually for a specified duration provided by the hospital. Additionally, the anaesthesia involved is also discussed along with its effects. Parents are encouraged to offer comfort and reassurance during this phase to ease anxiety.

After the surgery, children are generally stable and allowed to go home the same day. For mild discomfort, the doctors may prescribe certain pain relief medications. It is important to limit activities like sports for at least 2-3 weeks. Wearing snug-fitting underwear and following up on appointments are essential steps towards healing and recovery.