Back to Program


Left Subclinical Varicoceles Are Associated with Clinical Progression
Richard N. Yu, M.D., Ph.D., Harriet J. Paltiel, MD, David A. Diamond, MD.
Children's Hospital Boston, Boston, MA, USA.

BACKGROUND:
Subclinical varicoceles represent an ultrasonographic abnormality of the pampiniform plexus detected during scrotal ultrasound. A precise definition has not been agreed upon. However, at minimum, the diagnosis is based on the presence of the venous abnormality on ultrasound in the absence of a clinically detectable varicocele on the ipsilateral side. The objective of this study was to examine the dynamic nature of subclinical varicoceles diagnosed in a tertiary care center, focusing on ultrasound-based determination of resolution and progression and correlation with clinical examination findings.
METHODS:
We performed a retrospective review of all patients in our department with the diagnosis of subclinical varicocele between 2000 and 2009. Information obtained included age at diagnosis, ultrasound findings, ultrasound measured testis volumes, and clinical examination findings. Ultrasound results suggestive of progression or resolution of subclinical varicoceles were reviewed by a single radiologist. Subclinical varicoceles were defined by ultrasound findings of dilatation of the pampiniform venous plexus involving 2 or more vessels with vessel diameter ≥ 2.5mm (with or without Valsalva maneuver) without clinical evidence of a varicocele on physical exam.
RESULTS:
Sixty-three patients were identified in our database with a diagnosis of subclinical varicocele. Forty-eight (76%) had subclinical varicoceles on the right, 12 (19%) on the left, and 3 (4.5%) bilateral. Forty-seven (75%) patients had contralateral left clinical varicoceles. A total of 37 patients had two or more consecutive ultrasound studies suitable for longitudinal review. Progression of subclinical to clinically evident left varicoceles on exam occurred in four patients (10%). Three of these patients originally presented with a left subclinical varicocele and one presented with bilateral subclinical varicoceles. None of our patients with right subclinical varicoceles developed clinical varicoceles after 2.45 years of follow-up. Testis size differentials ≥ 20% were noted in 19 patients overall (30%) and were not associated with the development of clinically evident varicoceles.
CONCLUSIONS:
Few studies have examined the long-term outcome of subclinical varicoceles. One prior study suggests that up to 28% of these patients can progress to a clinically detectable varicocele. However, in a population of patients with large numbers of concomitant left clinical varicoceles, we observed the development and maintenance of right subclinical varicoceles. None of these incidentally discovered varicoceles progressed to clinical detection. Only patients with left subclinical varicoceles or bilateral varicoceles were observed to progress to clinically evident left varicoceles. These patients in particular may require routine annual ultrasound imaging and physical examination for varicocele detection.


Back to Program