Imaging the Infertile Male-1: Varicocele

Ultrasound of the male genital tract in relation to male reproductive health

“…While clinically assessed grade III varicoceles are easily diagnosed, detection of milder forms depends on the investigator's experience. In fact, palpation may be disturbed by cremasteric contraction, previous surgery, hydroceles or maldescended testis (see Liguori et al (2012)). Pathophysiologic mechanisms leading to varicocele formation and its clinical associations have been extensively described elsewhere (see Gat et al (2008) and ).…”

“…Venography of the internal spermatic vein is considered the goldstandard for varicocele detection (see Geatti et al (1991), Lee et al (2008) and Liguori et al (2012)). Its strength is the low susceptibility to technical variation and inter-observer variability (see Lee et al (2008)).…”

“…Its strength is the low susceptibility to technical variation and inter-observer variability (see Lee et al (2008)). However, venography is time-consuming, invasive and requires use of radiation (see Liguori et al (2012)). Hence, even if it is the most accurate technique for varicocele detection and often used for comparison with all the other diagnostic approaches in research studies, venography is currently indicated in clinical practice only in select cases (see Liguori et al (2012) , 2008).…”

“…However, venography is time-consuming, invasive and requires use of radiation (see Liguori et al (2012)). Hence, even if it is the most accurate technique for varicocele detection and often used for comparison with all the other diagnostic approaches in research studies, venography is currently indicated in clinical practice only in select cases (see Liguori et al (2012) , 2008). However, the diagnosis should be confirmed by CDUS (EAU Guidelines on Male Infertility, Jungwirth et al, 2013), especially when physical examination is inconclusive (AUA/ASRM, 2008).…”

“…However, the diagnosis should be confirmed by CDUS (EAU Guidelines on Male Infertility, Jungwirth et al, 2013), especially when physical examination is inconclusive (AUA/ASRM, 2008). In particular, CDUS has been found to have better diagnostic accuracy than physical examination (see Lee et al (2008)), and it is essential when physical examination is unreliable (Liguori et al, 2012) and considered the imaging modality of choice for detection and grading varicocele (Liguori et al, 2012), offering a more complete stratification of lower grades (Isidori and Lenzi, 2008). In addition, CDUS may identify those cases with markedly dilated vessels but without venous reflux, considered as 'false' clinical varicocele (Isidori and Lenzi, 2008), and is useful in detecting post-operative recurrence or persistence (Lund et al, 2000;Tefekli et al, 2001;Isidori and Lenzi, 2008).…”