# Varicocele (Evaluation & Referral) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: EAU Guidelines on Male Infertility 2023 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) - Verified date: 2026-08 ## Verified against - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Varicocele - disease-level clinical article (varicocele-referral-clinical.txt) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text VARICOCELE (EVALUATION & REFERRAL) Sources: EAU Guidelines on Male Infertility 2023 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) Review status: REVIEWED against Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), Varicocele - disease-level clinical article (varicocele-referral- clinical.txt), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Most varicoceles turn up incidentally on a routine exam or an infertility work-up, since they cause no symptoms [infertility] - When there is pain, it is usually a dull, aching, or throbbing discomfort rather than something sharp - A sense of heaviness in the scrotum can be a symptom - A large varicocele may be described by the patient as feeling like a bag of worms SIGNS - what you find (3) - A large varicocele shows the classic bag-of-worms look on plain visual inspection - A medium varicocele can be felt on palpation without the patient needing to bear down - A small varicocele is only felt when the patient performs a strong Valsalva maneuver TESTS (4) - Color-flow Doppler ultrasound confirms the diagnosis by showing pampiniform plexus veins of 3 mm or wider - A subclinical varicocele cannot be felt on exam and shows up only on ultrasound - A sudden, non-reducible, or right-sided varicocele raises concern for a retroperitoneal mass and warrants CT imaging - A same-visit right renal ultrasound alongside the scrotal study can catch a right renal mass or vena cava obstruction without added CT radiation IF NOT THIS - what else fits (2) - A paratesticular tumor is on the differential for a scrotal mass suggestive of varicocele - A scrotal lipoma or liposarcoma can present as a soft mass resembling a varicocele Source StatPearls "Varicocele" - disease-level clinical article Status traced to the source above 1. IBUPROFEN [1st line] Adult 400 mg three times daily after meals PRN for scrotal aching discomfort while awaiting urological evaluation - short-term PRN Peds 5-10 mg/kg/dose [child max 400 mg] (Every 6-8 hours PRN after food; refer adolescent varicoceles for pediatric urology evaluation. Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day. Never exceed 400 mg in a single dose.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: "The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)". Why NSAID used for symptomatic relief of scrotal aching in varicocele while awaiting urological evaluation; it manages discomfort only and does not address the underlying venous pathology. Caution Scrotal support and lifestyle modifications are core conservative measures. Urology referral is indicated for testicular volume loss or atrophy, infertility, or refractory pain. A sudden left varicocele in older men or ANY right-sided varicocele requires urgent abdominal ultrasound to exclude retroperitoneal tumor. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Varicocele - disease-level clinical article (varicocele-referral-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - An isolated right-sided varicocele, sudden onset, or a non-reducible varicocele indicates underlying retroperitoneal pathology or a renal mass. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)