Goal of the operation
In varicocele, the enlarged testicular veins are tied off to relieve the pooling of blood. The goal is to allow normal growth of the testicle, relieve pain and protect sperm quality in the future.
Methods
Microsurgical subinguinal varicocelectomy
The spermatic cord is brought out through a 2–3 cm incision just below the groin, and the operation is done under a microscope. The enlarged veins are tied off, while the testicular artery and lymphatic vessels are preserved.
- Advantages: the artery and lymphatic vessels are preserved under magnification; sparing the lymphatics reduces the risk of hydrocele.
- Drawback: it takes longer and requires microsurgical experience.
Laparoscopic varicocelectomy
The veins are tied off together through 3 small incisions in the abdomen. A special dye may be injected into the testicle to see and preserve the lymphatic vessels.
- Advantages: quick to perform, convenient for varicocele on both sides.
- Drawback: a higher risk of hydrocele if the lymphatic vessels are not preserved.
Embolization
A catheter is passed through a vein in the groin or neck, and the testicular vein is closed from the inside with a special material. There is no incision, but it requires X-rays and a procedure inside the blood vessels.
After surgery
- Mild pain for 1–2 days, simple pain relievers.
- Back to school after 2–3 days.
- No strenuous sports or cycling for 2–3 weeks.
- Supportive underwear adds comfort.
Follow-up
After 6–12 months, the volumes of both testicles are compared by ultrasound. In most adolescents, the smaller testicle catches up in size with the other after surgery.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Rapid swelling of the scrotum, severe pain
- High fever, pus from the wound
Note for pediatricians and family doctors
Lymphatic-sparing techniques (the microsurgical subinguinal approach or a laparoscopic approach with lymphatic dye) significantly reduce the risk of postoperative hydrocele. No single technique has been clearly shown to be superior in pediatric varicocele; the method is chosen based on the child's situation and the surgeon's experience. After surgery, testicular volume should be reassessed by ultrasound at 6–12 months; in most adolescents, the volume difference decreases.
What happens at the visit?
- The indication for surgery is based on testicular volume measured by ultrasound and on symptoms.
- The advantages and risks of each method are discussed with the teenager and the family.
- After surgery, testicular volume is checked by ultrasound at 6–12 months.
Frequently asked questions
Can the varicocele come back after surgery?
Yes, but rarely. The risk of recurrence depends on the method and the surgeon's experience; your child is followed up after surgery.
Why does a hydrocele form?
When the lymphatic vessels are tied off along with the veins, fluid collects around the testicle. Methods that spare the lymphatic vessels reduce this risk.
Related topics
Sources
- EAU Guidelines on Paediatric Urology, 2026: Varicocele.
- Silay MS et al. Treatment of varicocele in children and adolescents: a systematic review and meta-analysis. Eur Urol, 2019.
References to the EAU Paediatric Urology guidelines were checked against the 2026 edition (October 2026).
This information is for educational purposes and does not replace medical advice. Decisions about your child’s treatment are made with the doctor after an examination.
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