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11–14 APRIL, 2018, HELSINKI, FINLAND
16:54–16:57
S12-4 (PP)
ABDOMINAL ULTRASOUND IS UNECESSARY
IN VARICOCOELE EVALUATION
Martin KAEFER, Benjamin WHITTAM, Konrad SZYMANSKI, Katherine CHEN, Rosalia
MISSERI, Richard RINK and Mark CAIN
Indiana University School of Medicine, Pediatric Urology, Indianapolis, USA
PURPOSE
The evaluation and treatment of the pediatric varicocele remains controversial. The paradigm for
management has often been based on the strategy used for adults. It has been commonly taught
that an adult, who presents with sudden onset varicocele, bilateral varicoceles, or unilateral right-
sided varicocele, should be evaluated for an intra-abdominal process that could be causing external
compression of the gonadal vein. Abdominal ultrasound has been the modality of choice employed
in the evaluation of these individuals. We sought to determine the value of this practice in the
pediatric population.
MATERIAL AND METHODS
A retrospective chart review was made of all individuals presenting to our pediatric unit between
1999 and 2012. All patients who underwent abdominal imaging as a part of their evaluation were
included. Patients older than 18 years were excluded. Age at presentation, laterality, grade, calcu-
lated testicular size and mode of abdominal imaging were recorded.
RESULTS
Eighty-eight of 600 boys presenting with a varicocele underwent abdominal imaging (15 %).
Indications included left sided varicocele (48), bilateral varicocele (11), right-sided varicocele (5),
and recurrent varicocele (2). Twenty-two patients underwent abdominal imaging due to concern
over other systemic complaints (for example abdominal discomfort). A total of 98 imaging studies
were obtained (94 ultrasounds, 3 CTs, 1 MRI). In no case did the abdominal imaging reveal an
intraperitoneal process causing compression of the gonadal vasculature. One case of focal nodular
hyperplasia of the liver was identified in a patient with a left sided varicocele, but the involvement
was well away from the contralateral renal hilum and gonadal vein.
CONCLUSIONS
Although abdominal imaging for rapid onset left, bilateral, or unilateral right-sided varicoceles has
been proposed in adults, such screening is of negligible value in the pediatric population.