Advanced Biomedical Research

Determination of the best position and site for color Doppler ultrasonographic evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically

Authors

1 Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There are no generally accepted criteria for the ultrasonographic diagnosis and grading of varicocele. We aimed to determine the best position and site for color Doppler ultrasonographic (CDUS) evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically.
Materials and Methods: This study consisted of 103 men (44 normal and 59 with clinical varicocele). First, WHO clinical grade of varicocele was determined by physical examination. Then, the diameter of largest testicular vein at four different sites was measured in both upright and supine positions with or without Valsalva maneuver. Finally, the cut-off points of venous diameter for different clinical grades were determined using the values of the position and sites that had the strongest correlation with the clinical grades.
Results: The strongest correlation between venous diameter and clinical grade of varicocele was observed when the venous diameter was measured at the level of epididymal head in the upright position with Valsalva maneuver (r: 0.87, P-value < 0.0001). In aforementioned conditions, venous diameter of 2.35 mm (sensitivity 87%, specificity 87%) can distinguish normal subjects from grade 1 varicocele, venous diameter of 3.15 mm (sensitivity 58%, specificity 70%) can discriminate grade 1 from grade 2, and venous diameter of 3.75 mm (sensitivity 83%, specificity 70%) can differentiate grade 2 from grade 3. Furthermore, venous diameter of 2.65 mm (sensitivity 91%, specificity 89%) can distinguish normal subjects from patients with clinical varicocele.
Conclusion: The best position for CDUS examination of patients suspected of having varicocele is the upright position with Valsalva maneuver, and the best site for venous diameter measurement is at the level of epididymal head.

Keywords

1. Gat Y, Bachar GN, Zukerman Z, Belenky A, Gornish M. Varicocele: A bilateral disease. Fertil Steril 2004;81:424-9.  Back to cited text no. 1
[PUBMED]    
2. Carlsen E, Andersen AG, Buchreitz L, Jørgensen N, Magnus O, Matulevicuus V, et al. Inter-observer variation in the results of the clinical andrological examination including estimation of testicular size. Int J Androl 2000;23:248-53.  Back to cited text no. 2
    
3. Naughton CK, Nangia AK, Agarwal A. Pathophysiology of varicoceles in male infertility. Hum Reprod Update 2001;7:473-81.  Back to cited text no. 3
[PUBMED]    
4. Sakamoto H, Saito K, Shichizyo T, Ishikawa K, Igarashi A, Yoshida H. Color Doppler ultrasonography as a routine clinical examination in male infertility. Int J Urol 2006;13:1073-8.  Back to cited text no. 4
[PUBMED]    
5. Pilatz A, Altinkilic B, Kohler E, Marconi M, Weidner W. Color Doppler ultrasound imaging in varicoceles: Is the venous diameter sufficient for predicting clinical and subclinical varicocele? World J Urol 2011;29:645-50.  Back to cited text no. 5
    
6. Liguori G, Trombetta C, Garaffa G, Bucci S, Gattuccio I, Salame L, et al. Color Doppler ultrasound investigation of varicocele. World J Urol 2004;22:378-81.  Back to cited text no. 6
    
7. Mihmanli I, Korugoglu S, Cantasdemir M, Zulfikar Z, Halit Yilmaz M, Numan F. Color Doppler ultrasound in subclinical varicocele: An attempt to determine new criteria. Eur J Ultrasound 2000;12:43-8.  Back to cited text no. 7
    
8. Lee J, Binsaleh S, Lo K, Jarvi K. Varicoceles: The diagnostic dilemma. J Androl 2008;29:143-6.  Back to cited text no. 8
[PUBMED]    
9. Trum JW, Gubler FM, Laan R, van der Veen F. The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum Reprod 1996;11:1232-5.  Back to cited text no. 9
[PUBMED]    
10. Cina A, Minnetti M, Pirronti T, Vittoria Spampinato M, Canade A, Oliva G, et al. Sonographic quantitative evaluation of scrotal veins in healthy subjects: Normative values and implications for the diagnosis of varicocele. Eur Urol 2006;50:345-50.  Back to cited text no. 10
    
11. Caskurlu T, Tasci AI, Resim S, Sahinkanat T, Ekerbicer H. Reliability of venous diameter in the diagnosis of subclinical varicocele. Urol Int 2003;71:83-6.  Back to cited text no. 11
    
12. Hoekstra T, Witt MA. The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. J Urol 1995;153:82-4.  Back to cited text no. 12
[PUBMED]    
13. Hussein AF. The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol 2006;176:2141-5.  Back to cited text no. 13
[PUBMED]    
14. Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varicoceles. J Urol 1996;155:1287-90.  Back to cited text no. 14
[PUBMED]    
15. Kocakoc E, Serhatlioglu S, Kiris A, Bozgeyik Z, Ozdemir H, Bodakci MN. Color Doppler sonographic evaluation of inter-relations between diameter, reflux and flow volume of testicular veins in varicocele. Eur J Radiol 2003;47:251-6.  Back to cited text no. 15
[PUBMED]    
16. Orda R, Sayfan J, Manor H, Witz E, Sofer Y. Diagnosis of varicocele and postoperative evaluation using inguinal ultrasonography. Ann Surg 1987;206:99-101.  Back to cited text no. 16
[PUBMED]    
17. Schiff JD, Li PS, Goldstein M. Correlation of ultrasound-measured venous size and reversal of flow with Valsalva with improvement in semen-analysis parameters after varicocelectomy. Fertil Steril 2006;86:250-2.  Back to cited text no. 17
[PUBMED]    
18. Wolverson MK, Houttuin E, Heiberg E, Sundaram M, Gregory J. High-resolution real-time sonography of scrotal varicocele. AJR Am J Roentgenol 1983;141:775-9.  Back to cited text no. 18
[PUBMED]    
19. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 1970;21:606-9.  Back to cited text no. 19
[PUBMED]    
20. Arslan H, Sakarya ME, Atilla MK. Clinical value of power Doppler sonography in the diagnosis of varicocele. J Clin Ultrasound 1998;26:229.  Back to cited text no. 20
[PUBMED]    
21. Stahl P, Schlegel PN. Standardization and documentation of varicocele evaluation. Curr Opin Urol 2011;21:500-5.  Back to cited text no. 21
[PUBMED]    
22. Honig SC. New diagnostic techniques in the evaluation of anatomic abnormalities of the infertile male. Urol Clin North Am 1994;21:417-32.  Back to cited text no. 22
[PUBMED]    
23. Marsman JW. Clinical versus subclinical varicocele: Venographic findings and improvement of fertility after embolization. Radiology 1985;155:635-8.  Back to cited text no. 23
    
24. Meacham RB, Townsend RR, Rademacher D, Drose JA. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol 1994;151:1535-8.  Back to cited text no. 24
    
25. Cornud F, Belin X, Amar E, Delafontaine D, Helenon O, Moreau JF. Varicocele: Strategies in diagnosis and treatment. Eur Radiol 1999;9:536-45.  Back to cited text no. 25
    
 
Advanced Biomedical Research
Volume 2014, January
January 2014
Pages 1-5