One Of My Testicles Is Larger Than The Other

One Of My Testicles Is Larger Than The Other - Rob and Dave were undressing in the shower room after rugby when Dave noted his scrotum was different from Rob’s.

“Hey Rob, how come both yours are the same size?”

“It’s always been like this,” says Rob

“Mine’s not. The left one is bigger,” says Dave.

Rob told his friend Dave to see a doctor.

Thus, 14-year-old Dave persuaded his dad to bring him to see the family doctor, who examined Dave and suspected it could be a left-sided hernia, and so referred him to a paediatric surgeon.

The paediatric surgeon examined Dave and found that the left scrotum was much bigger compared to the right, and the left testes was smaller compared to the right one.

He suspected this was due to a left varicocele. Dave had a Doppler ultrasound of the scrotum, which confirmed the varicocele and a smaller left testes.

The ultrasound showed convoluted multiple channels in the left scrotum compared with the normal right, and when physically examining Dave’s left scrotum, the doctor felt “a bag of worms” there.

Hence, he declared to the boy and his dad: “It’s a bag of worms.”

This “bag of worms” is called a varicocele. It is the enlargement of veins within the loose bag of skin that holds the testes (the scrotum).

Varicocele occurs in about 16% of adolescent boys.

The incidence of paediatric varicoceles is underestimated as it is often not detected by doctors, and only discovered later in adult infertility clinics or never detected at all if no fertility issues arise.

A possible complication of varicocele includes impaired ipsilateral (same side) testes growth, noted to occur in 25%-75% of boys with varicocele.

It may not be apparent in the early stage, but as puberty progresses, affected boys are found to have a smaller than normal testes.

The cause is not known but it is thought that increased testicular temperature in the varicocele results in this.

It can result in impaired formation of sperm, hence infertility.

Most boys with varicocele have no symptoms apart from one scrotum being smaller than the other.

Some have a nagging ache in the affected scrotum.

There are four grades of varicocele:

• Grade 0: not felt or seen, only identified by ultrasound.

• Grades 1 to 3 are seen and felt. The testes must be examined, while the testicular volume can be checked using an orchidometer (Prader or Takihara models) or by ultrasound.

Whether to treat a paediatric or adolescent varicocele is a dilemma as not all varicoceles result in impaired testes growth or affect the formation of sperm.

Some studies have shown progressive deterioration of semen. Varicocele is found in 35% of primary sub-fertile adult males and 80% of secondary sub-fertile males (initially fertile, but later became infertile).

However, we cannot predict who will subsequently develop arrested testicular growth or who will be sub-fertile as an adult.

The only indication for surgery is a smaller affected testes. There are other relative indications for surgery that are best dealt with individually and with discussion with caregivers and the adolescent boy himself.

Surgical options can be open or laparoscopic, and there are many methods. The most recommended method currently is the micro-surgical approach.

Complications of surgery include recurrence of the varicocele, hydrocele, testes atropy (testes become very small) due to damage to the artery, and infection.

Dave’s parents, following discussions with the paediatric surgeon, and also with Dave, agreed to surgery.