[Bilateral varicocele: epidemiology, clinical presentation and diagnosis].
Epidemiology of bilateral varicocele (BV) was studied in 2600 patients with varicocele and in 3900 infertile patients 1196 of whom had varicocele. The diagnosis was made by examination, palpation of sexual organs, dopplerography. In addition, causes and clinical picture of BV were investigated. Targeted urological examination of 8000 schoolchildren detected varicocele in 1704 (22.8%) examinees, of them BV was in 290 (3.3%). Detailed examination with ultrasound in 1500 varicocele patients detected BV in 519 (34.6%). Among 1100 varicocele patients BV was detected after detailed examination in 328 (36%), after physical examination--in 156 (14.2%). Of 2900 infertile patients varicocele was diagnosed in 1196 patients, BV--in 312. After detailed examination BV incidence reached 41.2. Superselective testiculoflebography and multispiral computed tomography detected that in many BV patients right internal seminal vein enters the right renal vein. Asymptomatic right-side BV was detected in 1195 (96/0%) of 1245 BV patients, 397 (37.6%) patients with left-side BV had pain at exercise. At ultrasound examination the diameter of the scrotal part of the semenal vein in BV patients with right and left side disease in subclinical varicocele was from 1.5 to 4 mm (2.5 mm), in degree I--3-4 mm, in degree II--3.1-5 mm, in degree III--5.1-7.0 mm (in some cases up to 9 mm). The return blood flow rate in subclinical varicocele reached 0.100-0.120 m/s, in varicocele of the first degree--up to 0.150, of the second degree--up to 0.300 m/s and third--over 0.300 m/s. Thus, BV occurs much more often than is diagnosed. Adequate diagnosis rate can be achieved in using ultrasound methods.