Login to Access Video or Poster Abstract: MP35-16
Sources of Funding: None

Introduction

Varicocele is a common clinical entity, of which the majority occur on the left side due to normal venous drainage of the testis. Given the low incidence of isolated right varicocele (IRV), it has been suggested that men who present with an isolated right varicocele undergo retroperitoneal (RP) evaluation to exclude other pathology. Although there are numerous case reports of IRV preceding an associated RP pathology, the actual incidence remains unknown.

Methods

A retrospective chart review was performed of all men diagnosed with varicocele within a large, tertiary, academic system from 2000 to 2015. Medical records were queried for demographics, side of varicocele, imaging, and subsequent diagnosis of cancer or vascular anomaly. Cancers were considered relevant if within the retroperitoneum or peritoneum, and included renal, colon, prostate, bladder, adrenal, testis, and small bowel. Descriptive statistics are presented as mean(standard deviation) throughout. Comparative statistics include analyses of variance followed by Tukey-Kramer pair-wise comparisons, or chi squared tests for categorical data. All p < 0.05 are considered significant. Missing data points were excluded from analysis.

Results

A total of 4,060 patients with a diagnosis of varicocele (3258 left, 337 right, 465 bilateral). 81.9% self-identified as Caucasian, 7.8% African American, and the remaining proportion another race or declined to respond. Right varicoceles were diagnosed at significantly older age (43.6±17.1) than left (33.4±14.9, p<0.0001 ) or bilateral (34.9±15.3, p<0.0001) varicoceles. Right varicoceles were diagnosed in men with significantly higher body mass index (28.9±5.7) than left (26.4±5.5, p<0.0001) or bilateral (26.5±5.5, p<0.0001) varicoceles. Laterality of varicocele was not significantly associated with a relevant cancer diagnosis (p=0.313) with cancer in 2.67% of right, 1.63% of left, and 2.15% of bilateral varicoceles. Rates of abdominal CT imaging significantly (p<0.0001) differed by varicocele laterality, with 30.3% of right, 8.7% of left, and 11.2% of bilateral varicoceles having abdominal imaging. Diagnoses of venous thombi did not significantly differ by varicocele laterality.

Conclusions

Right varicocele presents at an older age than left or bilateral varicocele and is associated with an increased body mass index and greater likelihood of undergoing abdominal imaging. Rates of relevant cancer diagnoses did not differ with varicocele laterality, questioning the historical mandate to perform retroperitoneal imaging in all isolated right varicoceles.

Funding

None