Editorial comment

Abstract

This is a unique and important study; unique because venography, “reference standard,” was used in each instance to confirm the presence of a varicocele, and important because the diagnostic maneuvers used, contact thermography and venography, diagnosed a strikingly high frequency of bilaterality when only a unilateral varicocele was clinically suspected. Using a percutaneous retrograde venographic technique, these authors demonstrated that 85% of their patients had bilateral varicoceles present when the clinical examination had only indicated that one side was involved. Previous reports and these authors’ experience indicate that ISV reflux can only occur when the ISV valves are incompetent, resulting in a varicocele. This study, therefore, offers additional evidence to the findings already suggested by others cited that varicoceles are in fact often a bilateral disease. These patients underwent the “reference standard” of testing, allowing for objective validation of their findings, as well as validation of the accuracy of the other diagnostic modalities used.