Case Reports

LITHIASIS IN VARICOCELE VEINS: “VARICOLITHIASIS”

METE KILCILER, MUTLU SAGLAM, FAHRI SUMER, YAS� AR OZGOK, HASAN SOYDAN AND

DOGAN ERDURANFrom the Departments of Urology and Radiology, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey

KEY WORDS: lithiasis, varicocele

Spontaneous thrombosis of the left spermatic vein is rare,with few reports published in the literature.1–3 We report a caseof multiple free stones occurring in thrombosed varicocele veins.

CASE REPORT

A 20-year-old man presented with chronic left scrotal painand discomfort, especially in the upright position. On physi-cal examination the testes and epididymes were normal onpalpation but were remarkable for a grade III left varicocele.Multiple solid “bead string” lesions were also palpated in thevaricocele veins. The lesions were opaque on x-ray (fig. 1).Gray scale and color Doppler sonography using a 5 MHz.linear phased array transducer revealed a 6.5 mm. left sper-matic vein with multiple calcifications and acoustic shadow-ing. Roentgenographic examination and ultrasonography ofthe kidneys, ureters and bladder were normal.

Metabolic evaluation included serum electrolyte, creati-nine, calcium, phosphorus and uric acid tests. Hemogram,

urinalysis and urine culture were performed, and 24-hoururine samples were collected and analyzed for calcium, uricacid, creatinine, oxalate, sodium and citrate. In addition,urinary pH and volume were measured and were found to benormal. History, clinical examination and colony counts werealso obtained to exclude genitourinary infections.

Exploration of the left spermatic cord and testis showed anormal vas and testis but mobile solid lesions were palpatedin the varicocele veins (fig. 2). The varicocele vein segmentwas then excised and the solid lesions appeared as stones.Stone analysis demonstrated whitlockite calcium phosphate.However, histolopathological examination of the varicoceleveins revealed thrombosed large vessels with perivascularfibrosis and interstitial edema.

DISCUSSION

Spontaneous thrombosis of the left spermatic vein is a rareentity and was first described by McGavin in 1935.1 To ourknowledge no reports of lithiasis in thrombosed varicoceleveins have been published previously. In our case the preciseetiology of the condition is unknown. We found that all of thestones were free and mobile in the varicocele veins. However,we do not know how the stones formed in these veins.

REFERENCES

1. McGavin, D.: Thrombosis of the pampiniform plexus. Lancet, 2:368, 1935

2. Roach, R., Messing, E. and Starling, J.: Spontaneous thrombosisof left spermatic vein: report of 2 cases. J Urol, 134: 369, 1985

3. Gleeson, M. J., McDermott, M., McDonald, G. and McDermott,T. E.: Spontaneous thrombosis of the left spermatic vein. Br JUrol, 70: 567, 1992

Accepted for publication March 15, 2002.

FIG. 1. X-ray shows radiolucent centered multiple nodulardensities

FIG. 2. Intraoperative view of left spermatic vein and testis. Mul-tiple varicocele stones are visible.

0022-5347/02/1682-0630/0THE JOURNAL OF UROLOGY® Vol. 168, 630, August 2002Copyright © 2002 by AMERICAN UROLOGICAL ASSOCIATION, INC.® Printed in U.S.A.

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