Varicocoele and saphenofemoral reflux: are they coincidentally related?

Abstract

OBJECTIVE To determine whether a relation between varicocoele and venous insufficiency at the level of the saphenofemoral junction (SFJ) is present. PATIENTS AND METHODS A total of 100 patients with varicocoele and 50 age-matched controls seen in the outpatient urology clinic were included in our prospectively designed survey. Patients with a history of scrotal, inguinal or vascular surgery were excluded from the study. Following a physical examination by the same urologist, coloured Doppler ultrasonography of the pampiniform plexus and the SFJ were performed by the same radiologist. Patients who had spermatic veins greater than 3.0 mm in diameter and reversed blood flow in Doppler ultrasonography were included in the study group. The competence of the SFJ was evaluated and retrograde venous flow for longer than 0.5 s was noted as positive for saphenofemoral incompetence. RESULTS The mean age of varicocoele patients and the control group was 22.9 and 23.7 years, respectively. There were 83 patients with left varicocoele, five patients with right varicocoele and 12 patients with bilateral varicocoele. In the varicocoele group, 36 (36%) patients had saphenofemoral reflux while 64 (64%) had no reflux, whereas corresponding figures for the control group were 13 (26%) and 37 (74%) respectively (P= 0.32). There were 39 (46.9%) patients with a maximal vein diameter less than 3.6 mm (median 3.1 +/- 0.3 mm) while there were 44 (53.1%) patients with a maximal vein diameter over 3.6 mm (median 4.1 +/- 0.37 mm) (P= 0.20). CONCLUSION There is no statistically significant relation between varicocoele and SFJ insufficiency. Varicocoele may not be attributable to a systemic vascular insufficiency; however, further comprehensive series with larger populations are required