Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele?

Pilatz, Adrian; Altinkilic, B.; Köhler, Erika; Marconi, Marcelo; Weidner, W.

doi:10.1007/s00345-011-0701-4

Cited by 76 publications

(48 citation statements)

References 19 publications

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“…The most widely accepted criterion is presence of multiple veins with a diameter[3.0-3.5 mm in conjunction with reversal of flow on color Doppler ultrasound [35]. In a recent study, Pilatz et al [36] found that clinical varicoceles can be predicted with high accuracy (sensitivity [80 %, specificity [80 %) based only on the diameter of testicular veins, using cut off values of 2.45 mm (at rest) and 2.95 mm (during the Valsalva maneuver) in the supine position. An implication of that study is that Doppler evaluation is not necessary to assess clinical varicoceles, because a B-scan of vein diameters predicts clinical varicoceles with high accuracy.…”

Section: Treatment Indications and Varicocele Managementmentioning

confidence: 99%

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Kimura

Nagao

2014

Reprod Medicine & Biology

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Varicocele is an abnormal condition characterized by dilatation of the pampiniform plexus veins draining the testis and is present in 15 % of men. Varicoceles have an adverse effect on spermatogenesis and are the most common cause of male infertility. Approximately 35 % of infertile men and more than 70 % of men with secondary infertility were reported to have varicoceles. Although data on methods of varicocele repair are accumulating, there remains controversy regarding the indications and techniques for varicocele repair. In addition, the role of varicocele repair in this era of assisted reproductive technologies continues to be debated. In this study, we performed a comprehensive PubMed search in order to review the current status of varicocele repair for male infertility. We reviewed English-language studies published from 1992 through 2013. After reviewing the articles, we identified a recent meta-analysis of four randomized controlled trials, which found that varicocele repair for oligozoospermic men was associated with better pregnancy rates as compared with observation. Our review of prospective studies showed that all semen parameters, including sperm concentration, motility, and progressive motility, were significantly improved after varicocele repair. We also summarize the findings of recent studies reporting beneficial effects of varicocele repair, i.e., decreased oxidative stress and sperm DNA fragmentation after varicocele repair and superior cost effectiveness versus in vitro fertilization/intracytoplasmic sperm injection alone, which may be important in the era of assisted reproductive technologies. Varicocele repair is a widespread, well-established procedure that can improve semen parameters in men with infertility. The effect of such treatment on the pregnancy rate is unclear because evidence is limited due to difficulties in recruiting patients for studies. Among the repair techniques, microsurgical repair using a subinguinal approach is potentially the best practice, although this procedure requires training in microsurgery. All these topics require further research in studies with sufficient patient enrollment and follow-up.

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Section: Treatment Indications and Varicocele Managementmentioning

confidence: 99%

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Kimura

Nagao

2014

Reprod Medicine & Biology

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“…A pencil probe doppler (9 MHz) is inexpensive tool that may be helpful in diagnosing varicocele. Examination should be carried out with the patient in standing position and a venous "rush" produced by the blood reflux should be heard under valsalva maneuver [43]. Although simple, this method was also shown to be positive in men harbouring subclinical varicocele [44].…”

Section: Diagnosis Of Varicocelementioning

confidence: 99%

Varicocele and Male Infertility: Current Issues in Management-A Review

Sv¹

2014

Med Surg Urol

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Varicocele is the most common correctable cause of male factor infertility. The role of varicocele in the etiology of male infertility is still controversial regarding to whom varicocelectomy should be done and the selection should be meticulous. With the recent advances in biomolecular and development of novel sperm functional tests, it has been possible to better understand the mechanism involved in damage provoked by varicocele and therefore, propose ways to reverse them. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of assisted reproductive technology (ART) procedure required. This reveiw discusses current concepts on the mechanisms for varicocele induced testicular damage and efficacy of varicocelectomy for treatment of infertility. We also review the current guidelines and need for proper case selection before surgery.The authors critically reviewed the cost effectiveness of the surgical treatment of a varicocele compared with assisted reproductive techniques.

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“…26 In another study of 270 adult men, varicocele diag nosis was dependent upon an MVD of at least 2.45 mm at rest (sensitivity = 84%; specificity = 81%) or 2.95 mm during the Valsalva maneuver (sensitivity = 84%; specificity = 84%). 27 However, there is also evidence to suggest that reflux can occur in veins smaller than 2 mm in diameter. 28 In addition to its diagnostic role, MVD also has a prognostic role in adults.…”

Section: Vein Diametermentioning

confidence: 99%

The hemodynamic approach to evaluating adolescent varicocele

et al. 2012

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| During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack of spontaneous improvement in adolescent patients with ≥20% asymmetry between testes. CDUS also enables the detection of varicocele resulting from reflux in the deferential vein adjunctive to a refluxing internal spermatic vein; a causality that accounts for approximately 15% of cases. In addition to a diagnostic role, hemodynamic parameters can be used to predict the risk of persistence or worsening asymmetry. Although further studies are necessary to validate single parameters, it seems that the more severe the reflux, the greater the likelihood that the patient will develop testicular asymmetry.

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Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele?

Abstract: Our findings support the hypothesis that clinical varicoceles can be predicted with high accuracy based only on the diameter of testicular veins using cut-point values of >2.45 mm in rest or >2.95 mm during Valsalva maneuver in the supine position.

Cited by 76 publications

References 19 publications

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Varicocele and Male Infertility: Current Issues in Management-A Review

The hemodynamic approach to evaluating adolescent varicocele

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