Isolated Right Varicocele and Incidence of Associated Cancer

To test the classic teaching that isolated right varicoceles are associated with significantly high rates of occult malignancies.

Retrospective chart review included all men diagnosed with varicocele at the Cleveland Clinic from 2000 to 2015. Charts were queried for demographics, varicocele laterality, cross-sectional imaging, and subsequent diagnosis of abdominal malignancy or vascular anomaly. Descriptive statistics are presented as means ± standard deviation. Comparative statistics include analyses of variance with Tukey-Kramer pairwise comparisons or chi-square tests as indicated. All P <.05 are considered significant.

Varicocele was diagnosed in 4060 men (3258 left, 337 right, and 465 bilateral). Men with right varicoceles were significantly older (43.6 ± 17.1) than left (33.4 ± 14.9, P <.0001) or bilateral (34.9 ± 15.3, P <.0001), and had higher body mass indices (right 28.9 ± 5.7; left 26.4 ± 5.5, P <.0001 and; bilateral 26.5 ± 5.5, P <.0001). Laterality of varicocele was not significantly associated with cancer diagnosis (P = .313), with cancer diagnosed in 2.67% of right, 1.63% of left, and 2.15% of bilateral varicoceles. Rates of abdominal computed tomography imaging differed significantly (P <.0001) by laterality: 30.3% of right, 8.7% of left, and 11.2% of bilateral varicoceles were scanned. Vascular anomalies did not significantly differ by varicocele laterality.

Men with right varicoceles were older, heavier, and underwent more computed tomography scans than those with left or bilateral varicoceles but did not have higher rates of cancer diagnosis.