Home > Adults > Urology >

Varicocele

Checked: 23-11-2019 by Rob Adams Next Review: 23-11-2020

Who to refer

Varicoceles rarely need to be referred once diagnosed, unless large and bothersome or if there are other indications - see below:

Clinical Knowledge Summaries has information on the diagnosis and management of Varicocele .

The key points are:

The diagnosis is usually clinical but USS may be useful if there is diagnostic uncertainty (see the USS requesting guidelines for details of justified USS requests agreed for BNSSG).
In adolescents with varicocele, assess whether testicular growth arrest has occurred. If the testes are symmetrical, examine the boy once annually through puberty and refer to a urologist if there is testicular asymmetry (left smaller than right) or impaired testicular growth occurs.

Consider referral in the following situations:

A varicocele appears suddenly and is painful (urgent referral)
The varicocele does not drain when lying down (urgent referral)
There is a solitary right-sided varicocele (urgent referral).*
If there is pain or discomfort (routine referral)
Refer adolescents with a varicocele to a urologist if there are concerns about reduced ipsilateral testicular volume or If the boy or parents/guardians are concerned by the appearance, or symptoms, and cannot be fully reassured in primary care.

*The majority of varicoceles are left sided or bilateral. Isolated right sided is uncommon and can be associated with a retroperitoneal tumour (as right testicular vein drains directly into the IVC).

Do not routinely refer in the following situations:

Men or boys with a left-sided varicocele for ultrasonography to look for an underlying tumour.
Male partners of an infertile couple for varicocele surgery as a form of fertility treatment, as it does not improve pregnancy rate.

Red Flags

Refer for 2WW Urology or 2WW USS if:

Non-painful swelling or mass or change in shape of the body of the testis.

Urology 2WW

Before Referral

Examine patients in erect and supine positions to check that varicocele drains when lying down.

Consider USS if diagnostic uncertainty or patient not reassured by clinical examination (see the USS requesting guidelines for details of justified USS requests agreed for BNSSG)

Consider requesting Urology Advice and Guidance if more specific advice is required.

Referral

Refer if appropriate via eRS to Urology (16 and over) or paediatric urology (15 and under).

Please note that surgery for varicocele is not without complications and will not be offered for cosmetic reasons alone.

For fertility concerns then consider referral for Semen analysis.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.