Clinical outcome of pediatric and young adult subclinical varicoceles

Abstract

Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. As there is limited information on long-term outcome of subclinical varicoceles due to challenges in diagnosis and management, we performed a single-institution, retrospective review of patients from October 1999 to October 2014 with subclinical varicocele and with available US studies reviewed by a single radiologist. Subclinical varicocele was defined as dilation of the pampiniform venous plexus on US involving ≥2 vessels with diameter >2.5 mm, without clinical varicocele on physical examination or prior inguinal surgery. Thirty-six of 98 patients identified were confirmed as having a subclinical varicocele and analyzed. The mean age at initial visit was 15.5 years, with a mean follow-up of 26.5 months. The majority were right-sided (69.4%, n = 25), usually with a contralateral clinical varicocele. Testicular asymmetry (>20% volume difference of the affected side by testicular atrophy index formula) was assessed in 9 patients with unilateral subclinical varicocele without contralateral clinical or subclinical varicocele and observed in 1 patient. Of 17 patients with follow-up, 3 (17.6%) progressed to clinical varicocele without asymmetric testicular volume, as most remained subclinical or resolved without surgery. In our experience, subclinical varicoceles appeared unlikely to progress to clinical varicoceles, to affect testicular volume, or to lead to surgery. Although our study is limited in numbers and follow-up, this information may aid clinical management strategies and guide future prospective studies.

The Clinical Investigation on Varicocele and Sperm Quality in the Tibet an Plateau of China: A Prospectively Planned Retrospective Cohort Study

“…The clinical varicocele and grade were determined based on physical examination according to the Dubin and Amelar classification system (Cornud et al, 1999). Varicoceles were defined as follows: grade I = palpable venous dilation only during a Valsalva maneuver, not visible; grade II = palpable venous dilation without a Valsalva maneuver, not visible; and grade III = visible venous dilation without a Valsalva maneuver (Cho et al, 2021).…”

Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion

“…Testicular atrophy was defined as a decrease in testicular size (<80%) when compared with that of the unaffected testis (Figure 3c) 23 . Testicular size was evaluated via ultrasound 2–3 months after successful manual detorsion.…”

“…Testicular size was evaluated via ultrasound 2–3 months after successful manual detorsion. Testicular volume on ultrasound was estimated according to the following ellipsoid formula: length × width × thickness × 0.71 cm 3 23,24 …”

“…17,[20][21][22] Testicular atrophy Testicular atrophy was defined as a decrease in testicular size (<80%) when compared with that of the unaffected testis (Figure 3c). 23 Testicular size was evaluated via ultrasound 2-3 months after successful manual detorsion. Testicular volume on ultrasound was estimated according to the following ellipsoid formula: length 9 width 9 thickness 9 0.71 cm 3 .…”

“…Testicular volume on ultrasound was estimated according to the following ellipsoid formula: length 9 width 9 thickness 9 0.71 cm 3 . 23,24…”