Isolated Right-Sided Varicocele: Is Further Workup Necessary?

Unilateral left varicoceles are common and considered benign. Unilateral right varicoceles are reportedly associated with a pathologic process, namely malignancy affecting the retroperitoneum, for which further imaging is often recommended. The purpose of this study was to test the hypothesis that this correlation between unilateral right varicocele and malignancy may be weaker than once suggested, particularly in the absence of other clinical signs of malignancy. Medical charts and imaging at one institution were reviewed for all patients reported to have right varicocele. Follow-up cross-sectional imaging and clinical records and surgical and medical history were reviewed for possible nonmalignant or malignant causes of varicocele. Ninety-six patients with unilateral right varicocele diagnosed by means of ultrasound were identified. Twenty-nine (30.2%) patients were excluded because of confounding factors (infection, testicular mass, intrascrotal surgery). Among the other 67, 55 had available follow-up information, 39 with cross-sectional imaging. Right-sided varicocele was attributable to nonmalignant causes in 16 of the 55 subjects (29.1%) and to malignancy in two subjects: one with metastatic disease of undetermined primary and one with confluent liver masses. Both patients presented with other signs of malignancy and represented only 3.6% of the cohort who underwent follow-up. In this cohort, patients with right-sided varicocele attributable to malignancy presented with additional signs of metastatic disease. Nonmalignant causes were more common. Therefore, confounding conditions should be considered when incidental isolated right varicocele is identified. Health care costs, patient anxiety, and unnecessary harm can be substantially reduced through modulation of follow-up recommendations based on additional findings at presentation.