Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
You should consider referring a patient with a varicocele for surgical intervention based on specific criteria, which differ for adolescents and adult men, and also include urgent referral indications NICE CKS.
- Urgent Referral:
- Refer urgently to a urologist if a varicocele appears suddenly and is painful NICE CKS.
- Also refer urgently if the varicocele does not drain when lying down NICE CKS.
- Adolescents (from age 10 years onwards):
- Refer to a urologist for possible surgery if they have a Grade II or III varicocele and asymmetrical testes NICE CKS.
- The primary indication for surgery in adolescents is testicular growth arrest NICE CKS.
- Refer if there are concerns about reduced ipsilateral testicular volume NICE CKS.
- Refer if the boy or parents/guardians are concerned by the appearance or symptoms and cannot be fully reassured in primary care NICE CKS.
- Adult Men:
- Refer to a urologist for possible surgery if they have a Grade II or III symptomatic varicocele NICE CKS.
- Refer to a urologist for possible surgery if they have a Grade II or III varicocele with abnormal semen parameters NICE CKS.
- Do not routinely refer the male partner of an infertile couple for varicocele surgery solely as a form of fertility treatment, as NICE and the Royal College of Surgeons do not recommend it for this purpose alone NICE CKS,NICE CG156.
- However, consider seeking specialist advice from a urologist or fertility specialist for men with a clinical varicocele, abnormal semen parameters, and otherwise unexplained infertility, especially if the female partner has good ovarian reserve NICE CKS.
- Refer routinely to a urologist if there is pain or discomfort NICE CKS.