Physical exam and ultrasound characteristics of right varicocoeles in adolescents with left varicocoeles

The published incidence of bilateral varicocoeles in adults is much higher than among adolescents. We investigated our adolescent varicocoele database to determine (i) the presence of subclinical and palpable right varicocoele s in boys with a left varicocoele, (ii) the effect, if any, of right varicocoele on asymmetry measurements and (iii) the difference in duplex doppler ultrasound (DDUS) findings between left varicocoele s and contralateral right varicocoele s. Among 506 boys with a known left varicocoele who underwent DDUS, the incidence of right clinical and subclinical varicocoele s as well as the influence of Tanner stage, varicocoele grade, laterality, peak retrograde flow (PRF) and maximum vein diameter (MVD) on testicular volume and asymmetry was examined using univariate and multivariate linear regression. Right retrograde flow was detected in 204 of 506 (40.3%) boys. Varicocoele grades were subclinical in 89 (18%), grade I in 51 (10%), grade II in 63 (12%) and grade III in 1 (0.2%). In patients with bilaterally palpable varicocoele s, increasing left grade was associated with greater testicular asymmetry (p = 0.02) and increasing right grade was associated with less testicular asymmetry (p = 0.01). Mean PRF and MVD values were lower in right as compared to left varicocoele s. Contrary to common perception, both subclinical and palpable right varicocoele s are frequently associated with left varicocoele s in adolescents. Although the contribution of right varicocoele s to fertility is controversial, these right varicocoele s can influence clinically relevant parameters, particularly testicular asymmetry, and thus influence which left varicocoele s undergo surgery.