The Doppler Assessment of Varicoceles and Internal Spermatic Vein Reflux in Infertile Men

Hirsh, A. V.; Cameron, K. M.; Tyler, J. P. P.; Simpson, Judith; Pryor, John P.

doi:10.1111/j.1464-410x.1980.tb02919.x

Cited by 125 publications

(68 citation statements)

References 11 publications

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“…The classification system proposed by Chiou et al [13] is based on a score system, which takes into consideration the vessel diameter (in mm), the sum of the venous diameters and the changes in blood flow velocity during the Valsalva maneuver. Other US classification systems are those proposed by Hoekstra [15], Hirsh [16], Oyen [17] and the recent system proposed by Iosa et al [14] ( Table 2).…”

Section: Classification Of Varicocelementioning

confidence: 99%

Children and adults varicocele: diagnostic issues and therapeutical strategies

et al. 2014

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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...

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Section: Classification Of Varicocelementioning

confidence: 99%

Children and adults varicocele: diagnostic issues and therapeutical strategies

et al. 2014

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“…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]. Currently, the standard diagnostic assessment of varicocele is physical examination and scrotal ultrasound/Doppler [45].…”

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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“…Valves were found to be present in the testicular veins in only 54% of males at postmortem examinations (25) Phlebography proved the absence of valves in the testicular vein of varicocele patients (26).…”

Section: Similar To Varicose Veins a Defect Of The Valvesmentioning

confidence: 99%

Pelvic and Peripheral Venous Insufficiency: Different Presentations and Common Pathophysiology

Soliman

atta

Youssef

2006

The Egypt. J. of Fert.y of Steri.

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Introduction: Varicose veins are related to other diseases including varicocele or utero-ovarian varices. On the base of close physiopathologic relationships between varicose veins and gonadal varicosity we decided to evaluate the features of pelvic venous insufficiency in patients affected hy varicose veins. Methods: Seventy patients with different grades of chronic venous insufficiency (CVI) were included in the study. The patients were evaluated pre-operatively by color Doppler for grading of gonadal varicosity and assessment of valvular incompetence in the peripheral veins. Post-operatively, the number of valves in the stripped veins was correlated to the degree of gonadal varicosity. Results: Thirty patients were proved to have both peripheral and pelvic venous insufficiency. Higher grades of gonadal varices were associated with lesser number of saphenous valves. There was a significant relation hetween the Doppler grading of venous reflux in gonadal & peripheral veins. Conclusions: The incidence of varicocele associated with CVI was higher than the incidence of isolated varicocele. The bilateral development of gonadal and peripheral varicosity in female patients refers to mechanical compression followed by axial reflux. The association of lesser number of valves in the saphenous veins with higher grades of varicocele raises the possibility of generalized valvular scarcity as a cause of venous insufficiency.

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The Doppler Assessment of Varicoceles and Internal Spermatic Vein Reflux in Infertile Men

Cited by 125 publications

References 11 publications

Children and adults varicocele: diagnostic issues and therapeutical strategies

Children and adults varicocele: diagnostic issues and therapeutical strategies

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

Pelvic and Peripheral Venous Insufficiency: Different Presentations and Common Pathophysiology

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