Is Varicocele a Bilateral Disease?

Abstract

While varicocele is considered to be a predominantly left-sided disease in 90% cases, the existence and implication of a contralateral varicocele over the right side, whether low grade or subclinical, are being largely overlooked. The concept of unilateral left varicocele exerting influence only on the ipsilateral testis could not sufficiently explain the overall decline in fertility as observed in infertile patients with varicocele. The lack of efficacy after varicocele repair in a significant number of patients represents another pitfall in the current practice. The deleterious effect of a left varicocele over the right testis has been shown in the absence of a varicocele over the right side. In addition, the high prevalence of a concomitant low-grade or subclinical right varicoceles in the presence of a clinical left varicocele represents another piece of evidence supporting the notion that varicocele may be a bilateral disease. Moreover, bilateral varicocelectomy resulted in better improvement in semen parameters in patients with clinical varicocele on one side with a contralateral low-grade or subclinical varicocele compared to unilateral varicocele repair. Although the conceptualization of varicocele as a bilateral disease seems reasonable, large-scale well-designed studies are eagerly required to further validate this hypothesis.