Your Questions

Question:


I hope you don’t mind me contacting you even though we live in Gloucestershire.  My 15 yr old son has developed a large (very obvious) left varicocele. Our GP has advised us to do nothing but I feel a consultant opinion would be helpful. My son hates it and wants it to go away so I feel he should be given more information regarding treatment options so that he can make an informed decision. I feel that it should be monitored at the very least. Is it reasonable to ask for a urology opinion? we are happy to pay for initial consultation if appropriate. I would appreciate your views, we just want to do the right thing to support him and to try to minimise any psychological effects.

Answer:


I don’t mind at all being contacted. I think it is very reasonable to ask for a urology opinion. There aren’t many Paediatric Urologists in the UK which are interested in this condition. As you can see from our website there are several reasons for surgery in teenagers with varicoceles which include:
1. Pain / discomfort
2. Difference in the size of the left testis becoming smaller than right
3. Poor sperm parameters
I would suggest that your son needs a testicular ultrasound to confirm the diagnosis and measure the testicular volumes. If there is a greater than 20% difference between the sizes of the left and right testis this is a definite reason for having surgery.
If they are symmetrical then it is not clear whether it is better to wait until there is a problem or offer early surgery. We are running a study to work out the answer to this question. Once your son is mature physically a sperm test can assess the sperm concentration and motility which are much better guides of fertility. If these are normal it is very reassuring, if they are below par then we would offer surgery.  We have a monthly varicocele clinic at Royal Manchester Children’s Hospital and are happy to see any patient under 16 years of age in the NHS. We would just need a letter from a GP (if your GP is not helpful please ask another GP in the practice to refer you). Our address is Department of Paediatric Urology, Manchester Children’s Hospital, Oxford Road, M13 9WL.
I hope this is helpful. David Keene.

Question:

I am writing to you today concerning about my operation and my healthy lifestyle. I was looking at the procedure of the key hole operation on your website, and the picture shows that 2 incisions were going to be made on the side of my abdomen. This concerned me because I am a frequent user of the gym and would like to build up my abdominal muscles. But I was worried that if those muscles were growing larger, it would affect the ability of the instruments navigating through. I was also wondering where the other cuts are going to be on my body apart from the two I mentioned, as on the website it says that you will make several cuts on the abdomen.

Also after the operation and the recovery period, I am thinking about joining a boxing club. But would the operation restrict me from doing that sport? If so, I would like to know for how long or would I ever be able to do it.

Answer:

I am glad you have had a look on the website. It is good that you are having a healthy lifestyle and want to build up your muscles. Actually it is much easier if you have good muscle tone both for us as surgeons but also as a patient recovering. The instruments we use are very small and push the muscles apart rather than cutting them so they heal really well. So boxing or gym training is fine after 3 weeks.
Basically carry on training!

Question:

I hope you don’t mind me contacting you, but I came across your contact details via ‘varicocele.org.uk‘.

I just wondered if you had any advice for me.

I noticed a varicocele on my left testicle when I was 16-17 years old, (I’m now 22).  After research, I discovered that it was unnecessary for it to be treated if it didn’t cause any pain.  Now that I’ve had it for a while and still doesn’t give me any pain or any real discomfort and the size of both testis seems to have stayed the same size, no atrophy at all (in my opinion), but am thinking about going to a doctor and asking for surgery, anyway.  The reason for this, is that I fear it will only give me progressive damage in the long run and effect fertility and testosterone levels.

Do you think getting it ‘fixed’ is a wise choice, despite there being no apparent effects on me? I’ve never been to my GP about it.  Also, do you think varicocele(s) affect testosterone levels and the thyroid? I feel I may have an underactive thyroid, because of this, but this may just be hypochondria or not linked at all.

Answer:

I am very happy to discuss with you about your varicocele.
You have obviously done your research. I can understand your worry about progressive damage and problems with fertility as some people have these problems.
I would ask your GP to refer you for a sperm analysis and an ultrasound of your testis to compare their size more accurately than you can at home. If your testes are the same size (less than 20% different) and your sperm tests are normal (the sperm concentration greater than 20 millions/ml and that 50% of them move forwards) then I would reassure you and suggest you avoid an operation.
If your sperm analysis is poor then I would suggest you ask your GP to refer an adult surgeon with good expertise in fixing varicoceles. We work in children’s hospitals operating on teenagers up to 18 years of age.
Please be in touch with any more questions.