title: Diagnosis of varicoceles in men undergoing vasectomy may lead to earlier detection of hypogonadism.
abstract: OBJECTIVE
  To determine the temporal relationship between vasectomy, varicocele, and hypogonadism diagnosis. Many young men undergo their first thorough genitourinary examination in their adult lives at the time of vasectomy consultation, providing a unique opportunity for diagnosis of asymptomatic varicoceles. Varicoceles have recently been implicated as a possible reversible contributor to hypogonadism. Hypogonadism may be associated with significant adverse effect, including decreased libido, impaired cognitive function, and increased cardiovascular events. Early diagnosis and treatment of hypogonadism may prevent these adverse sequelae.
  
  
  METHODS
  Data were collected from the Truven Health Analytics MarketScan database, a large outpatient claims database. We reviewed records between 2003 and 2010 for male patients between the ages of 25 and 50 years with International Classification of Diseases, Ninth Revision codes for hypogonadism, vasectomy, and varicocele, and queried dates of first claim.
  
  
  RESULTS
  A total of 15,679 men undergoing vasectomies were matched with 156,790 men with nonvasectomy claims in the same year. Vasectomy patients were diagnosed with varicocele at an earlier age (40.9 vs 42.5 years; P=.009). We identified 224,817 men between the ages of 25 and 50 years with a claim of hypogonadism, of which 5883 (2.6%) also had a claim of varicocele. Men with hypogonadism alone were older at presentation compared with men with an accompanying varicocele (41.3 [standard deviation±6.5] vs 34.9 [standard deviation±6.1]; P<.001).
  
  
  CONCLUSIONS
  Men undergoing vasectomies are diagnosed with varicoceles at a younger age than age-matched controls. Men with varicoceles present with hypogonadism earlier than men without varicoceles. Earlier diagnosis of varicocele at the time of vasectomy allows for earlier detection of hypogonadism.
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: joceline-liu@fsm.northwestern.edu.
authors.forename: Joceline S
authors.initials: JS
authors.lastname: Liu
authors.affiliation: Department of Urology, Warren Alpert Medical School, Brown University, Providence, RI.
authors.forename: Madeline
authors.initials: M
authors.lastname: Jones
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Jessica T
authors.initials: JT
authors.lastname: Casey
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Fuchs
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: John
authors.initials: J
authors.lastname: Cashy
authors.affiliation: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: William W
authors.initials: WW
authors.lastname: Lin
mesh_terms: D000328:Adult; D000367:Age Factors; D000556:Ambulatory Surgical Procedures; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014646:Varicocele / Q000175:diagnosis* / Q000453:epidemiology*; D014659:Vasectomy / Q000009:adverse effects / Q000379:methods*