Significance of color Doppler sonographic unilateral and bilateral varicoceles

Background: Varicocele is one of the most common correctable causes of male infertility. Although the role of clinical varicocele is well accepted, controversy continues concerning the prevalence and significance of the overlooked subclinical varicocele in male infertility. Materials and Methods: A high resolution 7.5 MHz linear-array transducer and a color Doppler flow imaging system with spectrum analysis were used on 96 subfertile men. Inguinal or high ligations of sonographically evident varicoceles including subclinical ones were carried out on 42 of these. Student's t test and chi-square analysis were used for evaluation of semen improvement and pregnancy rate. Results. Subclinical varicoceles were detected in 33 men (34%); false positive physical diagnosis was made in 11 patients (12%). Of the 68 men found to have Doppler sonographic evidence of varicoceles, 34 (50%) had left varicocele, 31 (46%) had bilateral varicoceles, and only three (4%) had isolated right varicocele. No statistical differences in preoperative values were found between the unilateral and bilateral varicocele males. The semen improvement rate of 24 unilateral varicocelectomy men and 18 bilateral varicocelectomy men was 71% and 72%, respectively (p > 0.05). The pregnancy rate was 42% and 39%, respectively (p > 0.05), with a minimum follow-up of one year. Conclusion: This study shows subclinical and bilateral varicoceles to be more common than previously thought. Subclinical varicocele detected by color Doppler sonography is no less important than clinical varicocele. Bilateral varicoceles may be no more harmful than unilateral ones if reliable diagnosis is made and earlier subclinical varicocelectomy is performed in subfertile men.