Resident Physician Desai Sethi Urology Institute, University of Miami Miller School of Medicine
Introduction: Varicocele is the most common reversible cause of male infertility, affecting up to 20% of healthy men and 40% in men with primary infertility. Since reproductive endocrinologists are the gatekeepers for male infertility care in North America, we hypothesized that varicocele will be underdiagnosed when compared to its reported prevalence. The objective of this study was to investigate the prevalence of varicocele in men being evaluated for infertility, and to determine rates of subsequent varicocele repair using varicocelectomy or venous embolization using a large, multicenter database containing over 75 million patient records from 48 healthcare organizations.
Methods: TriNetX, a large, multicenter electronic health record (EHR) was queried to establish a cohort of all men (18+) with a diagnosis of male infertility (ICD-10-CM N46). The cohort was used to identify those with a diagnosis of varicocele (ICD-10-CM I86.1). Rates of subsequent varicocele repair were determined by identifying men who received varicocelectomy (CPT 1008633, 55530, 55535, 55550) or venous embolization (CPT 37241) on the day of varicocele diagnosis or later.
Results: Out of 92,262 men with a diagnosis of male infertility in the network, only 10,520 (11.4%) had a diagnosis of varicocele. Mean age of men with varicocele was 42 [32 – 52]. Interestingly, varicocelectomy or venous embolization was performed in just 2,360 (22.4%) and 67 (0.64%) men with varicocele, respectively. Strengths of the study include large sample size, heterogeneity of the study population, and establishment of chronology of diagnoses and treatments. These results are limited by lack of data on severity of disease, as well as inconsistent data recording, missing data, and lack of context in which data were collected including age of spouse and associated female factor infertility evaluation.
Conclusions: In a large, cross-sectional electronic health record study, varicocele was underdiagnosed in men being evaluated for infertility when compared with prior epidemiological studies. A potential explanation for our findings is that evaluation of male fertility is commonly performed by reproductive endocrinologists, which may result in fewer male physical examinations and thus underdiagnosis of varicocele and fewer varicocele repairs. This study is the first to our knowledge to thoroughly investigate the epidemiology of varicocele and treatment for varicocele, including follow-up procedures after diagnosis.
Source of Funding: This work was supported by National Institutes of Health Grant R01 DK130991 and the Clinician Scientist Development Grant from the American Cancer Society to Ranjith Ramasamy.