Right-sided varicocele associated with situs inversus

Area of Science:

• Urology
• Vascular Surgery
• Radiology

Background:

• Varicocele, a common cause of male infertility, predominantly occurs on the left side due to anatomical differences.
• Right-sided or bilateral varicoceles warrant further investigation for potential retroperitoneal pathologies, including neoplasms.
• Vascular anomalies can occasionally present as the underlying cause of varicocele.

Observation:

• A patient with complete situs inversus presented with a right-sided varicocele.
• Intraoperative right internal spermatic phlebography was performed to investigate the etiology.
• The phlebography revealed the right internal spermatic vein draining into the right renal vein.

Findings:

• Valvular incompetence at the confluence of the right internal spermatic vein and the right renal vein was identified as the cause of the right-sided varicocele.
• This case demonstrates a rare presentation of varicocele secondary to a vascular anomaly in a patient with situs inversus.
• Internal spermatic phlebography proved effective in diagnosing the condition.

Implications:

• Intraoperative internal spermatic phlebography is recommended as a simple and safe diagnostic tool for right-sided or bilateral varicoceles.
• This technique aids in identifying the specific venous drainage and potential valvular incompetence.
• Accurate diagnosis through phlebography is crucial for effective management of complex varicocele cases.