Stop-type and shunt-type varicoceles: venographic findings.

Abstract

Forty-four patients with a left-sided idiopathic varicocele were examined with bidirectional Doppler ultrasound (US), physical examination, and percutaneous retrograde venography. On the basis of the Doppler findings, the varicoceles were classified as either stop type or shunt type. On venography, the stop-type varicoceles showed only retrograde blood flow (reflux) in the testicular (internal spermatic) vein, whereas each shunt-type varicocele showed both retrograde and orthograde (i.e., physiologic) venous blood flow: First, reflux appeared in the testicular vein, then orthograde flow occurred in the deferential vein, cremasteric vein, or both. The shunt-type varicocele therefore represented a kind of venous bypass. Thus, the existence of two hemodynamically different types of varicocele as suggested initially by Doppler US is confirmed by percutaneous retrograde venography. The shunting of venous blood appears to be a precondition for medium and large varicoceles and might have some prognostic significance for subfertility associated with varicoceles.

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

“…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.…”

Association between varicocele and chronic obstructive pulmonary disease

“…2 Varicocele is an abnormal tortuosity and dilation of the testicular veins and pampiniform plexus. 11,12 It is relatively common in the general male population, 12,13 with a prevalence of approximately 15% in healthy males. Varicocele is present in 40% of the clinically infertile male population.…”

Intratesticular arterial resistance and testicular volume in infertile men with subclinical varicocele

“…4,28 The position of incompetent valves relative to the communicating veins determines the type of varicocele. Stop-type varicocele occurs when the incompetent valves are cephalad to the communicating veins; this type comprises only approximately 14% of all varicoceles.…”

“…In stop-type varicocele, only retrograde flow into the pampiniform plexus is present; in shunt-type varicocele flow is both orthograde (in the normal direction) and retrograde. 28,29 CDUS has a sensitivity of 83-95% in detecting subclinical varicoceles. 10,17 It has been reported that venous diameter has the greatest predictive value of the 3 sonographic diagnostic criteria (ie, large venous diameter, retrograde venous flow during Valsalva's maneuver, and tangles of veins 7 ); the first 2 criteria listed are those most commonly used as diagnostic criteria.…”