Clinical Guidelines for Varicocele
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Clinical Guidelines for Varicocele
December 8, 2025

What is varicocele?

Varicocele is a dilation of the veins in the spermatic cord. They are more common on the left side, and they most often occur during or after puberty. Varicoceles are common in adolescent boys and may be identified on physical examination or incidentally on scrotal ultrasound.

Diagnosis and testing for varicocele

Depending on the severity of the varicocele, you will feel or see the dilated veins in the scrotum. The diagnosis can be confirmed with ultrasound. Historically, differences in testicular size guided the decision to perform a varicocelectomy. More recently, we have incorporated hormone markers and semen analysis into decision making to determine when intervention or observation is most appropriate. 

Treatment for varicocele

When surgery is needed, we typically perform microscopic varicocelectomies through a small groin incision. Microscopic varicocelectomies have high success rates and low complication rates. These are performed as outpatient procedures. 

Why CHOP 

  • We incorporate hormone markers and semen analyses into decision making, which help avoid unnecessary surgeries and repeated ultrasounds.
  • Our research focuses on leveraging the electronic health record to personalize and optimize care for individual patient use.

When to refer a patient to CHOP

  • At the time of diagnosis for a baseline assessment and to develop a long-term plan to monitor children with varicocele
  • Right sided varicoceles are unusual and should be referred to rule out other pathologies

Related publications

  1. Van Batavia, J. P., Lawton, E., Frazier, J. R., Zderic, S. A., Zaontz, M. R., Shukla, A. R., Srinivasan, A. K., Weiss, D. A., Long, C. J., Canning, D. A., & Kolon, T. F. (2021). Total Motile Sperm Count in Adolescent Boys with Varicocele is Associated with Hormone Levels and Total Testicular Volume. The Journal of urology, 205(3), 888–894. https://doi.org/10.1097/JU.0000000000001405
  2. Chu, D. I., Zderic, S. A., Shukla, A. R., Srinivasan, A. K., Tasian, G. E., Weiss, D. A., Long, C. J., Canning, D. A., & Kolon, T. F. (2017). Does varicocelectomy improve semen analysis outcomes in adolescents without testicular asymmetry?. Journal of pediatric urology, 13(1), 76.e1–76.e5. https://doi.org/10.1016/j.jpurol.2016.09.010
  3. Chu, D. I., Zderic, S. A., Shukla, A. R., Srinivasan, A. K., Tasian, G. E., Weiss, D. A., Long, C. J., Canning, D. A., & Kolon, T. F. (2017). The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study. Journal of pediatric urology, 13(1), 77.e1–77.e5. https://doi.org/10.1016/j.jpurol.2016.09.008
  4. Kolon T. F. (2015). Evaluation and Management of the Adolescent Varicocele. The Journal of urology, 194(5), 1194–1201. https://doi.org/10.1016/j.juro.2015.06.079
  5. Kolon, T. F., Glassberg, K. I., & Van Batavia, J. P. (2014). Varicocele: early surgery versus observation. The Journal of urology, 192(3), 645–647. https://doi.org/10.1016/j.juro.2014.06.037
  6. Christman, M. S., Zderic, S. A., & Kolon, T. F. (2014). Comparison of testicular volume differential calculations in adolescents with varicoceles. Journal of pediatric urology, 10(2), 396–398. https://doi.org/10.1016/j.jpurol.2013.12.007
  7. Christman, M. S., Zderic, S. A., Canning, D. A., & Kolon, T. F. (2014). Active surveillance of the adolescent with varicocele: predicting semen outcomes from ultrasound. The Journal of urology, 191(5), 1401–1406. https://doi.org/10.1016/j.juro.2013.11.020
  8. Christman, M. S., Zderic, S. A., & Kolon, T. F. (2013). Comparison of semen analyses in youths with a history of cryptorchidism or varicocele. The Journal of urology, 190(4 Suppl), 1561–1565. https://doi.org/10.1016/j.juro.2013.02.017
  9. Kolon, T. F., Clement, M. R., Cartwright, L., Bellah, R., Carr, M. C., Canning, D. A., & Snyder, H. M., 3rd (2008). Transient asynchronous testicular growth in adolescent males with a varicocele. The Journal of urology, 180(3), 1111–1115. https://doi.org/10.1016/j.juro.2008.05.061
  10. Delaney, D. P., Carr, M. C., Kolon, T. F., Snyder, H. M., 3rd, & Zderic, S. A. (2004). The physical characteristics of young males with varicocele. BJU international, 94(4), 624–626. https://doi.org/10.1111/j.1464-410X.2004.05013.x