Children and adults varicocele: diagnostic issues and therapeutical strategies

Abstract

Varicocele is defined as abnormally dilated scrotal veins. It is present in 15 % of normal males and in 40 % of males with infertility. This disorder is a challenge for the physicians involved in the diagnosis and treatment, as the pathophysiology of varicocele is not yet completely understood. For this reason, accurate diagnostic criteria and clear indications for treatment in asymptomatic adolescents or adults with clinical or subclinical varicocele are still not defined. Ultrasonography (US) is considered the best method for calculating the volume of the testicles, measuring vein diameter and monitoring the growth of the testis in adolescent patients. Color-Doppler US is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele. Various classification systems have been published with recommendations on how to perform US imaging of the scrotum. Currently, color-Doppler US and spectral analysis are the most effective, non-invasive diagnostic procedures as they allow detection of subclinical varicocele associated with infertility. Various techniques are used in the treatment of varicocele including open surgery, laparoscopic procedures and interventional radiology. However, there is no consensus among physicians on which technique is the most effective in terms of outcome and complication rates. This review shows that color-Doppler US is currently the most widely employed diagnostic method for detection and classification of varicocele caused by venous reflux, as it is reliable and easily performed. The review also highlights the role of varicocelectomy in the management of adult male infertility.Riassunto Il varicocele è una dilatazione abnorme delle vene scrotali. Esso si riscontra nel 15 % degli uomini normali e nel 40 % dei soggetti che presentano infertilità. Rappresenta ancora oggi un problema clinico per gli specialisti che sono coinvolti nella diagnosi e nel trattamento di questa affezione, in quanto i meccanismi fisiopatologici che stanno alla base di questa patologia non sono stati ancora chiariti in maniera completa. Per questi motivi non esistono ancora indicazioni condivise tra i medici sulle possibilità diagnostiche e sulle scelte terapeutiche da applicare negli adolescenti asintomatici o negli adulti con varicocele clinico o subclinico. L'esame ultrasonografico dello scroto viene considerato attualmente come la metodica migliore per calcolare il volume dei testicoli, per misurare il diametro dei vasi venosi e per seguire l'accrescimento testicolare negli adolescenti. Il Color-Doppler è il metodo più semplice e preciso per studiare e documentare l'inversione del flusso nelle vene spermatiche e serve per una precisa classificazione del varicocele. Sono state proposte numerose classificazioni cliniche ed ecografiche del varicocele e sono state pubblicare raccomandazioni su come condurre l'esame ecografico dello scroto per l'identificazione del varicocele. Attualmente il color-Doppler associato all'analisi spettrale è la procedura diagnostica più 18...

Comparison of Sperm Parameters in Patients with Infertility Induced by Genital Infection versus Varicocele

“…Color Doppler is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele, regarding World Health Organization (WHO) 2000 guidelines on male infertility which state that a varicocele diagnosis should be confirmed by color Doppler (5). The contemporary review (11) shows that color Doppler is currently the most widely employed diagnostic method for detecting and classifying varicocele caused by venous reflux, as it is reliable and easily performed. Both testicular units were examined in supine and upright positions and during normal inspirium and Valsalva maneuver.…”

Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele

“…Varicocele is clinically defined as an abnormal dilation of the veins of the pampiniform venous plexus and the testicular veins with continuous or intermittent reflux of venous blood[4,5,11]. Primary varicoceles are due to venous reflux into the pampiniform plexus from the internal spermatic vein because of incontinent venous valves, and they usually occur on the left side.…”

“…A clinical varicocele is found in approximately 15% of all adult males, up to 35% of infertile men and 81% of men presenting with secondary infertility. When classified according to semen analysis parameters, 12% of infertile men with normal semen analyses and 25.4% of those with abnormal results were found to have clinical varicocele[4,5,8,12,14]. This disorder may be present at birth or in young children, but the incidence substantially increases in adolescents coinciding with pubertal development[4,5,14].…”

“…When classified according to semen analysis parameters, 12% of infertile men with normal semen analyses and 25.4% of those with abnormal results were found to have clinical varicocele[4,5,8,12,14]. This disorder may be present at birth or in young children, but the incidence substantially increases in adolescents coinciding with pubertal development[4,5,14]. The prevalence of varicocele also increases with advancing age, with an increase of approximately 10% per decade of life, probably because of the aging of venous valves[14].…”

A challenging ‘bag of worms’

“…Color-Doppler US is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele. Currently, color-Doppler US and spectral analysis are the most effective, noninvasive diagnostic procedures, as they allow detection of subclinical varicocele associated with infertility [39].…”