What to do now

1. See a urologist or surgeon for a physical examination
   • Grade I means the varicocele is usually detectable only with straining, not necessarily at rest.
   • Because it is on the right side, the doctor should confirm it clinically and ask whether it was sudden in onset, persists when lying down, or is associated with abdominal symptoms. Isolated right-sided varicocele sometimes merits additional assessment to exclude an abdominal or kidney cause, especially if new, large, or non-reducing. Bailey & Love’s Short Practice of Surgery, p. 1585.
2. If you have no pain and are not trying for pregnancy
   • Usually, no operation is needed.
   • Observation, supportive underwear, avoiding prolonged standing/heavy straining if it worsens symptoms, and review if symptoms change are reasonable.
3. For discomfort or dragging pain
   • Wear supportive briefs or an athletic supporter.
   • Use simple pain relief such as paracetamol. An anti-inflammatory pain medicine may help if a clinician says it is safe for you, particularly if you have no kidney disease, ulcer/bleeding history, blood-thinner use, or allergy.
   • If pain continues despite conservative measures, discuss a procedure with a urologist. Pain improves after repair in many, but not all, patients.
4. If fertility is a concern
   • Get a semen analysis, ideally two samples on separate occasions if the first is abnormal.
   • Varicocele treatment is generally considered when there is:
     • a clinically detectable varicocele,
     • abnormal semen parameters, and
     • otherwise unexplained difficulty conceiving.
   • Current European guidance advises against treating a subclinical varicocele or treating solely because ultrasound shows dilated veins when semen analysis is normal. EAU male-infertility guidance supports repair for the above fertility indication.

When a procedure is considered

• Microsurgical varicocelectomy: ligates the abnormal veins while preserving the artery and lymphatics. Often the preferred surgical approach when fertility is the reason.
• Percutaneous embolisation: an interventional radiology procedure that blocks the affected vein through a catheter. It avoids an incision and is also used for symptomatic cases.
• Laparoscopic/open surgery may be used in selected settings.

Seek urgent assessment now if you develop

• sudden severe testicular/scrotal pain
• a hard swollen testicle, fever, redness, vomiting
• a rapidly enlarging right-sided scrotal swelling
• blood in urine, unexplained weight loss, flank/abdominal pain

Worth getting before the urology visit

1. Semen analysis
   Get this if you are trying to conceive now or may want children in the near future. It is the most useful test for deciding whether a varicocele needs treatment.
   • Usually do 2 samples, about 2 to 3 weeks apart if the first is abnormal.
   • Abstain from ejaculation for 2 to 7 days before each collection.
   • It assesses sperm count, motility, morphology, and semen volume.
2. Abdominal and renal ultrasound Your report describes an isolated right-sided varicocele. Although it is small, this is less common than a left-sided one. An ultrasound of the kidneys and abdomen, ideally with Doppler if locally available, is a sensible test to arrange or discuss promptly with the urologist. It checks for uncommon causes of impaired venous drainage.
   The EAU guideline states that isolated clinical right varicocele should be assessed further for abdominal, retroperitoneal, and congenital causes. EAU diagnostic guidance

Only if indicated by your history or examination

1. Morning hormone tests, if you have low libido, erectile difficulty, reduced shaving/body hair, breast enlargement, low energy, very small testes, or an abnormal semen analysis:
   • Total testosterone, 8 to 10 am
   • FSH and LH
   • Prolactin if low libido/erectile symptoms or suspected hormonal issue
   • Sometimes SHBG and calculated free testosterone
   Do not start testosterone injections, gels, or “testosterone boosters” if fertility matters, because external testosterone can markedly reduce sperm production.
2. Urine routine examination and urine culture Only if you have burning urination, fever, discharge, blood in urine, pelvic pain, or recurrent urinary infection symptoms.
3. STI testing Only if there is urethral discharge, painful urination, epididymal pain/swelling, or relevant sexual exposure. Typical tests are urine NAAT for chlamydia and gonorrhoea, with other tests guided by history.

Usually not needed before the visit

• Repeat scrotal Doppler immediately, since you already have one.
• CT or MRI abdomen for everyone. The urologist will decide if these are needed after examination and abdominal/renal ultrasound findings.
• Tumor markers, unless there is a testicular lump or suspicious lesion, which your report does not show.
• “Sperm DNA fragmentation,” antisperm antibodies, or genetic tests as routine first-line tests.

Take to the urologist

• This ultrasound report and images if available
• Semen analysis results, if obtained
• A note of: pain severity, whether swelling disappears when lying down, when it started, fertility history, past surgery/trauma, and any abdominal/flank symptoms.