Irregular Scrotal Swelling (Varicocele)

External genitals in a 8-year-old boy with irregularly increased left scrotum. The skrotal skin is not involved, and the left scrotal pouch is irregularly swollen. The diagnosis is varicocele of the left side (keyword 'a bag full of worms'). Varicocele may be observed in toddlers and schoolchildren and mainly at puberty, too. Because the deficit of testicular volume which may be present in juvenile patients with varicocele is reversible in 3/4 following ligation and resection of the corresponding (left) spermatic vein and of its branches, and because sterility occurs in 1/3 of adult patients with varicocele surgery is recommended in children, too. Symptomatic varicocele are infrequent; nevertheless, the site of origin of the left spermatic vein should be examined during ultrasound which is performed for staging (graduation) of the varicocele and for determination of the exact size of the testis. Surgical are mainly the idiopathic varicocele in the toddler and schoolchild, huge varicocele (grade 3), and varicocele at puberty with a deficit of testicular volume.