When should I consider referring a patient with a varicocele for surgical intervention?

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 ¹.

• Urgent Referral:
• Refer urgently to a urologist if a varicocele appears suddenly and is painful ¹.
• Also refer urgently if the varicocele does not drain when lying down ¹.
• 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 ¹.
• The primary indication for surgery in adolescents is testicular growth arrest ¹.
• Refer if there are concerns about reduced ipsilateral testicular volume ¹.
• Refer if the boy or parents/guardians are concerned by the appearance or symptoms and cannot be fully reassured in primary care ¹.
• Adult Men:
• Refer to a urologist for possible surgery if they have a Grade II or III symptomatic varicocele ¹.
• Refer to a urologist for possible surgery if they have a Grade II or III varicocele with abnormal semen parameters ¹.
• 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 ¹,⁴.
• 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 ¹.
• Refer routinely to a urologist if there is pain or discomfort ¹.