Varicocele: strategies in diagnosis and treatment

Abstract

Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. However, palpability of the spermatic vein and reflux in low grade or even questionable varicoceles can be difficult to assess without imaging modalities. This can be a common problem for all physicians treating hypofertile men to decide whether the varicele needs to be treated or not. However, a gold standard that defines the presence of a subclinical varicocele has not yet been established. The different diagnostic tools based on ultrasonography investigated these past years to define a flow reversal in incontinent spermatic veins are presented in the first part of this review, with emphasis on subclinical varicocele. In the second part, we present our experience, together with a review of the literature concerning embolization of the spermatic veins as an alternative to surgery to treat varicoceles.

Incidence and importance of reflux in testicular veins of healthy men evaluated with color duplex sonography

“…17,19,20 Because venography is invasive and expensive, requires specialized equipment, and is associated with morbidity, its use is inappropriate for routine screening for varicoceles. 2,5,17 Other methods, such as thermography, continuous-wave Doppler sonography, and radioisotope techniques, are no longer used.…”

“…Keywords: testicular vein; re¯ux; color duplex ultrasonography; varicocele A varicocele is an abnormal tortuosity and dilatation of the testicular veins and pampiniform plexus that is pathophysiologically characterized by retrograde flow in testicular veins. 1,2 It is difficult to estimate the incidence of varicoceles because most of them are impalpable and asymptomatic and are diagnosed only with sonographic evaluation. 3 The estimated incidence of clinically palpable varicoceles is 15% in the general, population of men and 21À39% in subfertile men.…”

Technical aspects of embolization of internal spermatic vein in varicocele treatment

“…Takav ishod prvenstveno zavisi od tehnike izvođenja i obučenosti lekara. Klinički manifestno poboljšanje postiže se na levoj strani u preko 95% slučajeva, a na desnoj strani ređe (65%-85% ) (18). Perzistencija varikokele posle embolizacije je retka (do 5% ) (18)(19)(20) za razliku od hirurške ligature (do 45%) (4).…”

Is There Any Additional Benefit of Venous Diameter and Retrograde Flow Volume as Measured by Ultrasonography to the Diagnosis of Suspected Low-Grade Varicoceles?

“…While many researchers stated that venography is the gold standard method for the diagnosis of varicocele, venography has not become widespread as it is invasive and expensive, requires special equipment and has a morbidity of 0.5-1% [1,5,10,11] . Color Doppler ultrasonography is a noninvasive and easily applicable method that quantitatively measures both blood flow parameters in spermatic vein and size of the pampiniform plexus [12,13] .…”

“…Varicocele, which is defined as abnormal tortuosity and dilatation [1] characterized with pathologic retrograde flow in testicular veins and pampiniform plexus, has a prevalence of 2-22% among adult males and 25-40% among infertile men [2] . Although physical examination is accepted as the standard method for the diagnosis of varicocele, it has limited capacity in determining the changes in blood flow and is a subjective assessment that might change among clinicians especially in lowgrade varicoceles [3,4] .…”