Varicocoele and saphenofemoral reflux: are they coincidentally related?

Abstract

8 5 3What ' s known on the subject? and What does the study add? It has been proposed that there is a signifi cant relation between varicocoele and saphenofemoral refl ux.Our results show that there is no statistically signifi cant relation between varicocoele and saphenofemoral refl ux. OBJECTIVE• To determine whether a relation between varicocoele and venous insuffi ciency 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 fl ow in Doppler ultrasonography were included in the study group.• The competence of the SFJ was evaluated and retrograde venous fl ow 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, fi ve patients with right varicocoele and 12 patients with bilateral varicocoele.• In the varicocoele group, 36 (36%) patients had saphenofemoral refl ux while 64 (64%) had no refl ux, whereas corresponding fi gures 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

The association between varicocele and other vascular diseases: A systematic review and meta-analysis

“…18 In contrast to previous studies, Yazici also carried out a prospective age-matched study which found no statistically significant relationship between saphenofemoral insufficiency and varicocele. 10 The authors of the study suggested that this discrepancy could be accounted for by the significantly larger number and the relatively younger varicocele patients included. In recent years, other studies have reported findings consistent with the present study and hypothesized that a systemic vascular insufficiency could explain their findings; however, the exact cause is still unclear.…”

“…Five of the seven included case-control studies reported the risk of saphenofemoral insufficiency in the varicocele and control groups. 6,[8][9][10]13 In four studies, saphenofemoral insufficiency was defined as femoral saphenous reflux time greater than 0.5 s. In one remaining study, femoral saphenous reflux was defined as retrograde flow of more than 1 s. Ultimately, 872 cases were included, with 482 cases in the varicocele group and 390 cases in the control group. The pooled analysis indicated that the risk of saphenofemoral insufficiency in the varicocele group was higher than that in the control group (OR: 2.80; 95% CI: 2.03, 3.84; p < 0.00001; Figure 4), and low heterogeneity in the pooled effect estimates was found (p = 0.32; I 2 = 14%; Figure 4).…”

“…8,9 In contrast, an age-matched case–control study designed by Yazici et al reported no significant relationship between varicocele and saphenofemoral insufficiency. 10 Accordingly, given the heterogeneity of reported results, the association between varicocele and other vascular diseases remains a matter of debate, warranting further investigation.…”