Varicocele In Children: Symptoms, Diagnosis, And Treatment

Varicocele in children can cause testicular pain and pressure due to diminished blood drainage and enlargement of the scrotal veins (pampiniform plexus). It is common and affects nearly 15% of children and teens (1). Left-sided varicocele may occur in most boys than right-sided varicocele since there is a change in the angle at which the blood drains from the scrotum to the kidneys. If not treated appropriately, a pediatric varicocele may increase the risk of infertility later in life.

Read on to know about the causes, symptoms, diagnosis, and treatment of varicocele in children.

Risk Factors And Causes Of Varicocele In Children

The exact cause of varicocele is not known. Most children may not have any significant risk factors for developing varicocele. However, malfunction or absence of valves inside the spermatic cord veins (a band of tissue containing nerves, ducts, and blood vessels connecting the abdominal cavity and testes) is believed to cause varicocele (2).

When the blood supply to the scrotum increases during puberty, it might cause excess blood build-up in the veins. In addition to blood pooling, pressure in the veins increases due to groin anatomy and results in swelling. Sometimes swollen lymph nodes may block blood flow through scrotal veins.

Symptoms Of Varicocele In Children

Varicocele can be asymptomatic (no symptoms) in most boys. However, a few may experience the following symptoms (3):

• Testicular pain or scrotal pain or an ongoing dull ache in the scrotum
• Testicular asymmetry where one testicle may look smaller than the other
• Heaviness or discomfort in the testicles often worsens with exercise
• Swollen blood vessels can be felt in the scrotum

These symptoms can also be seen in other conditions. Seeking medical care could help for an exact diagnosis. You may also seek medical care if existing varicocele symptoms worsen or do not improve over time or if the child has new symptoms.

Complications Of Varicocele

Although varicoceles do not cause life-threatening complications, the following complications are seen in some cases (4) (5):

• Testicular atrophy is the shrinkage and softening of the testicle. The exact cause for testicular atrophy in varicocele is not known. Increased pressure in scrotal veins and the release of toxins from blood could cause testicular damage.

• Infertility may occur due to increased local temperature affecting sperm formation (spermatogenesis), function, and motility (movement). More abnormal or pathological forms of sperms are often seen in varicocele.

• Altered hormone levels can be seen in varicocele. The testosterone hormone levels can be affected by the change in the hypothalamic-pituitary-gonadal axis. Most children showed an improvement in testosterone levels after varicocele repair surgery.

Diagnosis Of Varicocele In Children

Doctors may diagnose varicocele during physical examinations (scrotal examination) for other reasons in asymptomatic children. Children with symptoms are referred to the pediatric urologist for a detailed evaluation. Doctors may perform a Valsalva maneuver to check smaller varicoceles. During this scrotal examination, the child has to stand, take a deep breath, and bear down (5).

A scrotal ultrasound will evaluate the size of the testicles and detect other clinical changes. If there is no serious concern, the urologist may schedule ultrasound examinations in the future to ensure the testicles are growing equally.

Treatment For Varicocele In Children

Most children and teens may not require varicocele treatment. If needed, doctors may choose the treatment depending on the child’s age, symptoms, severity, and general health.

The following measures and treatments are recommended for children with scrotal pain (3):

• Pain medications, such as acetaminophen or ibuprofen could offer quick relief from pain.

• Lying flat on the back might reduce pain since the blood drains easily from the scrotum in this position.

• Wearing supportive underwear, such as athletic underwear or briefs, may help ease the pain and discomfort.

The following treatments are usually recommended if the child has severe pain or a small testicle (5):

• Surgery if the size difference between the left and the right testicle is more than 20% on the ultrasound. It is either an open surgery involving an incision on the abdomen or below the groin area or laparoscopic surgery using special instruments. Surgical treatments can restore proper blood flow to the scrotum and improve fertility.

• Percutaneous embolization is a radiologic procedure to block and repair the varicocele. A catheter is inserted from the groin to the scrotal vein to release specific solution or coils that creates scar tissue and block the vein. This is not widely used as surgical treatment.

Doctors may order semen analysis for children or teens when they are 18 years. Although no symptoms are present, surgery is indicated if the sperm count is low in repeated semen analysis. This helps prevent future infertility (6).

Testicular examinations during a health check-up at a doctor’s office can help identify varicocele in children. Although harmless, all children with varicocele should be evaluated and treated since this may cause infertility in the future. You may also get the follow-up ultrasounds and semen analysis at recommended time for managing the condition.

References

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