Adolescent Varicocele: Incidence of Right-Sided Flow and Effect On Asymmetry?

Sunday, October 3, 2010: 2:40 PM
Yerba Buena Salon 9 (San Francisco Marriott Marquis)
Solomon L. Woldu, MD, Stephen A. Poon, MD, Ruslan Korets, MD, E. William Kirby, Anthony Gasalberti and Kenneth I. Glassberg, MD, FAAP, Division of Pediatric Urology, Department of Urology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York - Presbyterian, New York, NY

Purpose: We sought to identify the incidence of right retrograde flow in patients with a left varicocele, how that flow compared to that on the left, its relationship to right palpability, ipsilateral right testicular size, and thus possible influence on asymmetry measurements.

Methods: 518 boys with left varicocele who had undergone DDUS (duplex Doppler ultrasound) measurements were included in the study. Testicular volumes, peak retrograde flow (PRF) values, maximum vein diameter (MVD), and varicocele grade that was determined either immediately before and/or after the DDUS study were evaluated.

Results: Mean patient age was 16.9 years (range 10.1-21.7). The incidence of right-sided retrograde venous flow was 46.2% (181 patients). With careful palpation, and frequently with the knowledge that right flow was present, a right varicocele was palpable in 139 patients (35.0%) with 64 (16.1%), 69 (17.4%), and 6 (1.5%) classified as grades I, II, III, respectively. Of those 258 patients without a palpable right varicocele, 37.3% had DDUS evidence of retrograde venous flow and thus were designated as subclinical right varicoceles. DDUS findings demonstrated PRF ranges on right were lower, although comparable, to those on left when there was evidence of palpable ipsilateral varicocele. Right varicocele grade was negatively correlated with testicular asymmetry (p=0.039).

Conclusion: Contrary to what some pediatric urologists perceive, right varicoceles of varying size are frequently associated with left varicoceles. While we recognize that there is a greater likelihood of palpating a right varicocele when one knows beforehand that right retrograde flow exists, this is not necessarily a bad thing. Once these right varicoceles were graded, it was the grade rather than PRF that correlated with a lower degree of testicular asymmetry. Therefore, one must be aware of indolent right varicoceles, focus on the possibility of their presence, the possibility of being misled by the lower levels of testicular asymmetry that they are associated with and thus not operating on what might be a significant left varicocele.

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