To determine the useful parameters for predicting the development of moderate or severe lower urinary tract symptoms (LUTS) in patients with varicocele, we made a retrospective study.

115 men with varicocele, and 20 men without varicocele were recruited. The age of all the patients were >50 years old. They were divided into three groups: Group 1 patients with varicocele and moderate or severe LUTS (n=22), Group 2 patients with varicocele and without moderate or severe LUTS (n=93), Group 3 with control patients without varicocele and moderate or severe LUTS (n=20), respectively. The parameters for evaluation and comparison were included international prostate symptom scores (IPSS), age, testicular volume, scrotal temperature, peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), pulsatility index (PI) and peak retrograde flow (PRF) by color Doppler ultrasound. RI=PSV-EDV/PSV; and PI=PSV-EDV/maximal velocity of artery in the pampiniform plexus. Patients with moderate or severe LUTS had IPSS higher than 8.

Of 115 patients with varicocele, 93 (80.9%) were left; 16 (13.9%) bilateral and 6 (5.2%) right. Age (mean±SD) was 64.1±6.1, 58.1±5.2, and 57.3±5.1 years old in groups 1, 2, and 3, respectively; and IPSS (mean±SD) was 15.2± 5.1, 4.3±1.1, and 4.1±0.9 in groups 1, 2, and 3, respectively. Scrotal temperature (mean±SD) was 34.78±0.05℃, 34.44±0.04℃, and 34.42±0.04℃ in groups 1, 2, and 3, respectively. RI (mean±SD) was 0.52±0.08 ml/sec, 0.45±0.05 ml/sec, and 0.41±0.06 ml/sec in groups 1, 2, and 3, respectively, and PI (mean±SD) was 0.89±0.10 ml/sec, 0.87±0.08 ml/sec, and 0.85±0.08 ml/sec, in groups 1, 2, and 3, respectively. Patients in group 1 had higher IPSS, age, scrotal temperature, PI and RI than men in groups 2 or 3, but significant difference was noticed only in IPSS, age and RI. No significant difference was noticed for testicular volume, PSV, EDV, and PRF among the patients in three groups.

Decreased blood flow and increase temperature in the scrotum in older patients with varicocele might result in higher chance of developing moderate or severe LUTS.

Older patients with varicocele may suffer from LUTS. We might pay more attention to varicocele patients with RI>0.52ml/sec in pampiniform plexus and age> 64.1 years old.