Introduction

Learning objectives

Recognize the presentation of varicocele in adolescence.
Understand the importance of comparing testicular volume between the two sides.
Know that the indication for treatment depends on specialist evaluation, not on the mere presence of a varicocele.

2

Video lesson

▶

Video pending upload (embedded YouTube)

3

Summary

What is it?

It is a dilation of the veins of the pampiniform plexus.

In pediatrics it appears mainly during adolescence and is much more common on the left side.

How is it detected?

It is often a finding during a physical exam.

It may present as:

swelling;
visible scrotal veins;
a feeling of heaviness;
testicular asymmetry.

The patient should be examined standing, and the Valsalva maneuver can be used.

What matters most to us in adolescents?

Compare the size of both testicles.

A persistent decrease in the volume of the testicle on the affected side may be a relevant finding.

Does every adolescent varicocele need surgery?

No.

Management depends on:

symptoms;
testicular volume;
course;
characteristics of the varicocele;
specialist evaluation.

Key concept

In adolescents, the goal is not simply to detect the varicocele, but to assess whether it is affecting testicular development.

4

PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

5

Practical algorithm

Non-retractile foreskin in a young child, without scarring or complications → probably physiological → do not force.
Retracted foreskin that cannot be returned + edema → paraphimosis → emergency.
Testicle outside the scrotum after the first months of life → refer → do not wait years.
Painless, fluctuant scrotal swelling → consider communicating hydrocele.
Adolescent with varicocele → assess testicular development and volume.
Infant with fever without a source → consider urinary tract infection.
Recurrent febrile UTI → assess the need to investigate urinary anomalies/VUR.
Sudden testicular pain → urgently rule out testicular torsion.

In Pediatric Urology, the primary care physician does not need to resolve every condition: they need to distinguish the physiological from the pathological, and recognize when to observe, when to investigate, when to refer and, above all, when to act urgently.

6

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

7

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

8

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Varicocele