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Chronic Constipation as a Causative Factor for Development of Varicocele in Men

A Prospective Ultrasonographic Study

Ahmet T. Turgut, MD, Eriz Özden, MD, Pinar Koar, MD, Uur Koar, MD, Baak Çakal, MD and Ayhan Karabulut, MD

Departments of Radiology (A.T.T., P.K., U.K.) and Urology (A.K.), Ankara Training and Research Hospital, Ankara, Turkey; Department of Urology, University of Ankara, School of Medicine, Ankara, Turkey (E.Ö.); and Department of Gastroenterology, Yüksek htisas Hospital, Ankara, Turkey (B.Ç.).

Address correspondence to Ahmet T. Turgut, MD, 25. Cadde, 362. Sokak, Hüner Sitesi 18/30, Karakusunlar, 06530 Ankara, Turkey. E-mail: ahmettuncayturgut{at}yahoo.com

Objective. The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men. Methods. In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration ± SD of 17.0 ± 20.3 months (range, 3–96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously. Results. Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 ± 0.97 mm (range, 1.2–4.3 mm) in group 1 and 1.71 ± 0.53 mm (range, 1.0–3.0 mm) in group 2 (P < .001). A significant difference was detected between the two groups for varicocele prevalence and the mean diameter of the left PP veins. Conclusions. Chronic constipation is a significant causative factor for the development of left varicocele, which may be attributable to the accompanying distention of the sigmoid colon and distal part of the descending colon, with resultant compression of the left testicular vein in the retroperitoneum. Therefore, we propose routine ultrasonographic examinations for the possible development of varicocele in men with chronic constipation.

Key Words: constipation • scrotum • ultrasonography • varicocele

Abbreviations: PP, plexus pampiniformis