Is There a Co-Association Between Renal or Retroperitoneal Tumours and Scrotal Varicoceles? A Systematic Review

Abstract

Scrotal varicoceles, which are relatively common, are sometimes caused by venous flow disturbance resulting from a renal or retroperitoneal tumour. Consequently, it is common practice to perform extended renal and retroperitoneal scans following varicocele identification. The aim of this systematic review was to determine the extent of the co-association between renal or retroperitoneal tumours and scrotal varicoceles using primary research literature. We conducted a search of 11 electronic databases; hand-searched five relevant textbooks; and conducted forward- and backward-citation searches of included articles. Articles that were included were assessed for research quality and data extracted. Twenty-four articles were found, comprising 19 case reports and five case series, reporting 35 cases in total. All cases had both a varicocele and a tumour (renal, retroperitoneal or other). We found no cohort or case–control studies. In conclusion, case reports and case series are susceptible to significant publication bias and the lack of any cohort or case–control studies meant that it was not possible to establish the extent of the co-association between renal or retroperitoneal tumours and scrotal varicoceles. It was not possible to estimate the value of conducting an extended scan in patients with scrotal varicoceles. Research is needed, particularly of a cohort or case-control design and including a robust sampling method, to examine the extent of any co-association. Meanwhile, extended renal or retroperitoneal scans should be undertaken when diagnosing all varicoceles, regardless of patient age, until this research is completed.

Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations

“…Tumour thrombus in the right renal vein seldom results in the development of a right-sided varicocele, because the right spermatic vein commonly drains into the inferior vena cava, with the incidence of the right spermatic vein draining into the right renal vein reported in less than 5% of individuals [ 159 – 161 ]. Moreover, it has been shown that a secondary varicocele is as likely on the left side as the right, therefore, considering a secondary varicocele only in the rare situation in which it develops on the right is misleading [ 162 ].…”

Wilm’s tumor presenting with scrotal varicocele in an 11-month-old boy

“…Consequently, it is apposite to perform renal and/or retroperitoneal scan in children with varicoceles on scrotal sonography. [ 9 ]…”

Ultrasound of the Groin: A Pictorial Review

“…If varicocele is identified, it is obligatory to examine the testicles and the kidneys (Figure 17). 26, 27…”