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Isolated Right-Sided Varicocele: Is Further Workup Necessary?
Adam Gleason1, Kristen Bishop1, Yin Xi1
11 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230, Dallas, TX 75390-9316.
AJR. American Journal of Roentgenology
|February 20, 2019
Summary
Unilateral right varicoceles are rarely linked to malignancy, especially without other symptoms. Non-malignant causes are more common, suggesting a need to reconsider imaging recommendations for isolated right varicoceles.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Unilateral left varicoceles are common and benign.
- Unilateral right varicoceles have been associated with retroperitoneal malignancy, often prompting further imaging.
- The strength of this association, particularly in asymptomatic cases, requires re-evaluation.
Purpose of the Study:
- To test the hypothesis that the correlation between unilateral right varicocele and malignancy is weaker than previously suggested.
- To evaluate the necessity of extensive follow-up imaging for isolated right varicoceles.
Main Methods:
- Retrospective review of medical charts and imaging for patients with right varicocele at a single institution.
- Analysis of follow-up imaging, clinical records, and medical history to identify causes of varicocele.
- Exclusion of patients with confounding factors like infection or prior intrascrotal surgery.
Main Results:
- Sixty-seven patients with unilateral right varicocele were analyzed after exclusions.
- Non-malignant causes accounted for 29.1% of varicoceles in the follow-up cohort.
- Malignancy was identified in only two patients (3.6%), both presenting with additional signs of metastatic disease.
Conclusions:
- Right-sided varicoceles associated with malignancy typically present with other clinical indicators of metastatic disease.
- Non-malignant etiologies are more frequent causes of right varicoceles.
- Modulating follow-up recommendations based on presenting clinical signs can reduce healthcare costs and patient anxiety.
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