For a patient with intermittent hematuria and a left-sided varicocele, what is the most appropriate diagnostic procedure?

In the case of a patient presenting with intermittent hematuria and a left-sided varicocele, the most appropriate diagnostic procedure is an abdominal CT scan. This choice is driven by the need to evaluate the kidneys and the surrounding structures for potential causes of both symptoms.

The presence of intermittent hematuria raises concerns for a variety of conditions such as renal tumors, stones, or vascular anomalies. The left-sided varicocele, particularly if it's new-onset in an older male, can suggest possible obstruction of venous drainage from the left kidney, such as from a renal mass or other obstruction. An abdominal CT scan is highly effective in providing detailed imaging of the abdominal organs, including the kidneys and the vascular system, which would help identify any underlying pathologies contributing to both hematuria and varicocele.

While the other options can provide valuable information, they are not as comprehensive as an abdominal CT scan for this specific clinical scenario. Ultrasound of the abdomen may be useful for initial evaluation but is less definitive for identifying solid lesions or vascular issues. Urine cytology is more beneficial for evaluating suspected bladder cancer and does not address the varicocele or renal pathology directly. Cystoscopy would allow for direct visualization of the bladder and urethra