Varicocele

Reassure patients that they do not need any active treatment if their varicocele is not causing any symptoms or problems.

Advise patients with mild discomfort to wear supportive underpants, rather than boxer shorts, before discussing more invasive treatment options.

Adolescents with a grade II or III varicocele that is not treated should be asked to return yearly for physical examination and check on testicular growth.[24]Macey MR, Owen RC, Ross SS, et al. Best practice in the diagnosis and treatment of varicocele in children and adolescents. Ther Adv Urol. 2018 Jun 22;10(9):273-82. https://journals.sagepub.com/doi/10.1177/1756287218783900 http://www.ncbi.nlm.nih.gov/pubmed/30116303?tool=bestpractice.com ​ Patients and parents or carers should be counselled about the potential for reduced fertility in later life if the varicocele is not treated.[58]Laven JS, Haans LC, Mali WP, et al. Effects of varicocele treatment in adolescents: a randomized study. Fertil Steril. 1992 Oct;58(4):756-62. http://www.ncbi.nlm.nih.gov/pubmed/1426322?tool=bestpractice.com Studies including long-term outcomes (such as fertility) are lacking, and the optimum timing for treatment is unknown.[54]European Association of Urology. Guidelines on paediatric urology. Apr 2024 [internet publication]. https://uroweb.org/guidelines/paediatric-urology

Patients who are unable to conceive should be referred to a male fertility specialist.

Postoperative measures

Routine postoperative care includes suitable analgesia and wearing supportive underpants, which may also help reduce pain by relieving pressure in the testicles.

Activity levels depend on the operative technique; however, most patients can return to non-strenuous activities after 2 days and more strenuous activity (e.g., exercise) after 2-4 weeks. Inform patients that improvements in sperm quality may take several months.