What is possibly one of the first symptoms noticed in patients with varicocele?

In patients with varicocele, one of the first symptoms that is commonly noticed is the visible enlargement of the scrotum. Varicocele is characterized by the abnormal dilation of the veins within the spermatic cord, which may lead to a noticeable swelling. This swelling can be described as a "bag of worms" due to the numerous dilated veins present. The enlargement might not always be accompanied by other symptoms initially, making it a key early sign.

The other choices are generally not associated with varicocele as primary symptoms. Persistent pain around surgical sutures would more likely relate to complications of previous surgery rather than varicocele itself. Difficulty in urination is usually indicative of urinary tract issues or prostate problems, not varicocele, which affects the scrotal area. Similarly, a low-grade fever could signal an infection or systemic illness, again not directly linked to the presence of a varicocele. Thus, visible enlargement of the scrotum stands out as the hallmark initial symptom of varicocele.