Baseline Characteristics of the Patients
Totally 1202 military cases could be detected during the follow-up period, thirty-three were excluded as military family members and postoperative cases, a total of 1169 cases were included. Finally 225 cases developed varicocele (19.24%), including 182 cases of left varicocele, fourteen cases of single right varicocele and 29 cases of bilateral varicocele. The age ranged from 18 to 85 years, the internal diameter of varicose spermatic vein was between 3.00 mm and 5.80 mm, the volume of the right testis ranged from 7.34 cm3 to 50.49 cm3, the left ranged from 8.21 cm3 to 46.33 cm3. The number of people in grade I, II and III was 211, 12, 2, respectively. The comparison between the varicose veins and the normal military examination was shown in Table 1. Figure 1. showed an ultrasound image of a soldier with grade II varicocele on the left when the Valsalva action was in progress.
Table 1
Varicocele occurred in the military population compared with those without varicocele
Parameter
|
Varicocele cases
|
Without varicocele cases
|
P value
|
Age(y)
|
25
|
25
|
0.55
|
Inner diameter(mm)
|
3.2
|
1.8
|
0.00
|
Left testicular volume(cm3)
|
19.68
|
18.28
|
0.00
|
Right testicular volume(cm3)
|
18.72
|
19.13
|
0.40
|
Epididymis cyst
|
52
|
198
|
0.48
|
Testicular hydrocele
|
25
|
56
|
0.01
|
A total of 818 outpatient cases were included in this study, including 119 patients with varicocele (14.55%). Among them, 99 cases occurred on the left side, 7 cases occurred on the right side, and 13 cases were bilateral. The age range was 18 to 69y, the internal diameter of varicose spermatic vein was between 3.00 mm and 5.10 mm, the volume of the left testis ranged from 5.88 cm3 to 48.41 cm3, the right ranged from 7.98 cm3 to 42.69 cm3. The number of patients in class I, II and III was 108, 9, 2, respectively.
Comparisons between the two groups
The incidence of varicocele was higher in military patients than in general outpatients (P < 0.05), while there was no difference in varicose grade and lateral position (P > 0.05). Military cases were younger and had a smaller bilateral testicular volume (P < 0.05), there were no significant differences between varicose internal diameter of spermatic vein, the incidence of epididymal cyst and fluid accumulates around the testis (P > 0.05). The comparison results can be seen in Table 2.
Risk factors and correlation analysis
Age, inner diameter width of spermatic vein, bilateral testicular volumes, the presence of epididymal cyst and testicular sheath effusion were taken as risk factors for binary logistics regression analysis (Table 3). It can be found that left testis volume got smaller (P = 0.000, OR = 0.896), the right became bigger (P = 0.033, OR = 1.052) and the disappearance of fluid aroud the testiculars (P = 0.007, OR = 0.505) were independent risk factors for varicocele, while age, the innner diameter of the spermatic vein and epididymis cyst were not. Among the three independent risk factors, the first two items were continuous variables, which mean that the risk of varicocele was 0.896 times higher for each unit decreased in left testicular volume; for each unit increased in right testicular volume, the risk of varicocele was 1.052 times higher than that before the increase.
Correlation analysis revealed that there’s no correlation between age, varicose inner diameter of spermatic vein, the appearance of epididymal cyst and testicular hydrocele (P > 0.05).
Table 2
Comparison of basic information of military personnel and general outpatients
Parameter
|
Military cases
|
Outpatient cases
|
P value
|
Age(y)
|
25
|
30
|
0.00
|
Inner diameter(mm)
|
3.2
|
3.2
|
0.93
|
Left testicular volume(cm3)
|
19.68
|
22.68
|
0.02
|
Right testicular volume(cm3)
|
18.72
|
21.24
|
0.00
|
Epididymis cyst
|
52
|
26
|
0.79
|
Testicular hydrocele
|
25
|
11
|
0.59
|
Grade
|
-
|
-
|
0.86
|
Grade I
|
211
|
108
|
-
|
Grade II
|
12
|
9
|
-
|
Grade III
|
2
|
2
|
-
|
Side of varicocele
|
-
|
-
|
0.58
|
Bilateral
|
29
|
13
|
-
|
Single right
|
14
|
7
|
-
|
Table 3
Risk factors of varicocele in military group
Parameter
|
β
|
EXP (β)
|
95%CI of EXP (β)
|
Wald
|
P value
|
Age(y)
|
0.003
|
1.003
|
0.983–1.024
|
0.087
|
0.769
|
Inner diameter(mm)
|
−153.314
|
0.000
|
0.00-∞
|
0.004
|
0.947
|
Left testicular volume(cm3)
|
−0.110
|
0.896
|
0.860–0.934
|
26.770
|
0.000
|
Right testicular volume(cm3)
|
0.051
|
1.052
|
1.004–1.103
|
4.533
|
0.033
|
Epididymis cyst
|
−0.124
|
0.883
|
0.624–1.250
|
0.493
|
0.483
|
Testicular hydrocele
|
−0.637
|
0.505
|
0.307–0.828
|
6.061
|
0.007
|