Lower prevalence of varicoceles in obese patients found on routine scrotal ultrasound

Research shows that obese patients have a lower incidence of varicoceles. Increased adipose tissue, which makes physical examination difficult, was hypothesized to be the cause. We evaluated the varicocele incidence on routine scrotal ultrasound to see whether difficult physical examination was causative.

We reviewed all scrotal ultrasounds from the last 2 years for men 18 to 40 years old who had a recorded body mass index. Physical examination findings and the indication for ultrasound were included. We used standard criteria for ultrasound detected varicoceles. National Institutes of Health criteria was used to classify patients as normal-body mass index less than 25 kg/m(2), overweight-25 to 30 or obese-greater than 30.

Of the 1,079 patients 330 (30.6%) had an ultrasound detected varicocele. Mean ± SD body mass index in those with vs without a varicocele was 26.7 ± 3.8 vs 26.0 ± 3.7 kg/m(2) (p = 0.04). On physical examination 171 patients (16.0%) had a varicocele. Mean body mass index in those with vs without a varicocele on physical examination was 26.6 ± 3.7 vs 26.4 ± 3.9 kg/m(2) (p = 0.09). We calculated varicocele frequency by body mass index for ultrasound detected varicoceles only. Of 374 normal weight patients 129 (34.5%) had a varicocele while in the overweight and obese groups 163 of 535 (30.6%) and 43 of 170 (25.6%), respectively, had a varicocele. The difference between normal and obese patients was statistically significant (p = 0.04).

Obese patients have a lower prevalence of varicoceles detected by ultrasound. The lower prevalence is independent of physical examination and more likely due to another factor.