P-648: Clinical, sonographic, and intra-operative assessment of varicoceles: Does the data correlate?

Abstract

There are no prior studies correlating clinical grade, pre-operative sonographic vein size, and intra-operative vein size measured at the time of microsurgical subinguinal varicocelectomy. The purpose of this study was to compare varicocele grade and pre-operative sonographic data with intra-operative vein size at the time of varicocelectomy. This is a prospective, non-randomized review of 64 consecutive men who underwent microsurgical subinguinal varicocelectomy. A total of 64 consecutive men (mean age 34.5 yrs) were enrolled in this study. Twenty-six underwent unilateral microsurgical subinguinal varicocelectomy, of which 23 were left and 3 right. The remaining 38 patients underwent bilateral varicocelectomy for a total of 102 varicocele units. Varicoceles were clinically graded I-III. Pre-operatively, 53 varicocele units had sonographic size available. At surgery, the diameter of the largest internal spermatic vein at the external inguinal ring was measured using a sterile micro-ruler prior to ligation. For clinical grade I varicoceles, the mean sonographic size (n=15) was 2.7 mm (± 0.7), and the mean intra-operative size (n=20) was 3.5 mm (± 0.9). For grade II varicoceles, the mean sonographic size (n=21) was 2.4 mm (± 1.2), and the mean intra-operative size (n=42) was 3.7 mm (± 0.9). For grade III varicoceles, the mean sonographic size (n=17) was 3.5 mm (± 1.5), and the mean intra-operative size (n=40) was 5.2 mm (± 1.6). Using analysis of variance (ANOVA) with Scheffe multiple comparison adjustment, clinical grade was predictive of intra-operative vein size (p<0.0001). Intra-operative vein size for grade III varicoceles was significantly larger than that of grades I and II varicoceles (p<0.0001). There was no significant difference in intra-operative size between grades I and II (p=0.78). Clinical grade was also predictive of sonographic vein size (p=0.03). However, this correlation was only significant between grades II and III varicoceles after post-hoc adjustment (p=0.03). There was no significant linear correlation between sonographic and intra-operative vein size (r2 = 0.12, p = 0.38). Clinical varicocele grade is predictive of intra-operative vein size. Clinical grade is also predictive of pre-operative sonographic varicocele size, although this difference is only significant between grades II and III varices. There was no significant correlation between pre-operative sonographic vein size and intra-operative vein size. Sonographic and intra-operative vein size may be useful additional predictors of varicocelectomy outcome.