Sometimes varicocele don’t cause symptoms at all. So the patient may have a varicocele that doesn’t need treatment and can just be watched. But in other patients, some can present with pain, swelling, or decreased fertility. The way that we diagnose a varicocele is with a physical exam, or we find it as an incidental finding on an ultrasound.

We grade varicoceles, which basically tells us if it’s a low grade varicocele or a high grade varicocele. Grading of varicoceles goes from zero to three. For example, a grade zero varicocele is one that can not be felt on physical exam, but can be seen on an ultrasound image. A grade three varicocele on the other side of the spectrum is one that you can see prior to your physical exam with your hands, but you can actually see with the naked eye, through the skin. And so what we see as urologists is a man will come to me, maybe with testicular pain and on my physical exam I’ll find a varicocele, or a patient will be referred to me for subfertility, and in my workup for him on an exam, I may feel a varicocele.

There are reasons why varicocele need to be treated, and there are reasons why varicocele shouldn’t be treated. What we should think about when we think of varicocele, is the patient is symptomatic or not? If you have a varicocele and you’re not symptomatic, you’re probably not gonna need treatment.

If you are symptomatic, meaning you have decreased fertility, such as a sperm count not being good or motility not being good on a semen analysis. These are reasons we may want to even repair varicocele. Varicoceles that are found on imaging, but are not able to be felt on exam, often don’t require treatment.

What I recommend is if you come in and you have pain in your testicle, I’ll evaluate you for a varicocele, or if you’re felt to have a varicocele by your primary care physician and want to check a semen analysis, we can have a discussion about your varicocele and come to the right treatment option for you. I’m Russell Libby with Northwoods Urology of Texas. Thanks for listening today. You can visit us online at northwoosdurology.com or give us a call to make an appointment.