Introduction and Objectives
We examined the first-degree relatives of men with known varicocele to reveal the familial risk for varicocele.
Material and Methods
This study consisted of two phases: a retrospective review of patient charts and prospective physical examination and collection of data. In the first phase, all charts of patients with clinical varicocele who presented with infertility, testicular pain, or aesthetic problems between June 2008 and May 2009 were reviewed. Of the 113 patients, 49 (43.4%) agreed to have their available first-degree relatives contacted for screening of varicoceles. Of the 92 first-degree relatives contacted, 66 (71.7%) decided to participate in this study. In the second phase, all first-degree relatives included in this study were examined for varicocele and data collcted. All first-degree relatives were asymptomatic and had neither a history of infertility nor a prior diagnosis of a varicocele.A cohort of 100 consecutive men who applied to the department of internal medicine for check up procedure without a history of subfertility or a varicocele were used as a control population. All men in the control group had undergone an equal detailed physical examination by the same urologist as the study population. The severity of varicoceles have been classified according to standard grading system. The chi-squared test was used to compare the prevalence of varicoceles in our first-degree relatives and our control group.
Past medical history revealed that none of the first-degree relatives of patients had surgery for varicocele or retroperitoneal disease which may affect gonadal veins. Of the 66 first-degree relatives, 21 (33.9%) had a palpable varicocele on physical examination. Among these men, 4 (21.1%) of 19 fathers and 17 (36.2%) of 47 brothers had palpable varicocele. Eighteen men had a unilateral left varicocele and 3 bilaterally palpable varicoceles. Of the 100 men used as a control group, 12 (12%) had a palpable varicocele on physical examination. Of the 12 patients, 8 had a unilateral left varicocele and 4 bilaterally palpable varicoceles. Compared with control population (12%), the prevalence of palpable varicocele in the first-degree relatives of patients with known varicocele (33.9%) was approximately 3-fold higher (P < 0.005) (Table 1).
Table 1.Properties of patients, first-degree relatives, and the control group
|Grading of Varicoceles|
|No. (n)||Varicocele (%)||Unilateral n (%)(left/right)||Bilateral n (%)||Grade 1 n (%)||Grade 2 n (%)||Grade 3 n (%)|
|Patients||49||49/49 (100%)||43 (87.8) (43/0)||6 (12.2%)||3 (5.5)||17 (30.9)||35 (63.6)|
|First-degree relatives||66||21/66 (33.9%)|
|18 (85.7) (18/0)||3 (14.3%)||7 (29.2)||8 (33.3)||9 (37.5)|
|Control||100||12/100 (12%)||8 (72.7) (8/0)||4 (27.2%)||2 (12.5)||6 (37.5)||8 (50)|
* p< 0.005 compared with control group
A significant increase in varicocele prevalence is present in the first-degree relatives of men with known varicoceles. Patients should be counseled about this increased risk in male relatives of patients.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.