Ultrasonographic diagnosis of varicoceles

OBJECTIVE: To assess the ability of color duplex scrotal ultrasonography to detect subclinical varicoceles and confirm the diagnosis of clinical varicoceles. DESIGN: Physical examination, color duplex scrotal ultrasonography and internal spermatic venography was performed on 64 testicular units in 33 men. SETTING: Male fertility center. PATIENTS: Two hundred sixty-two consecutive men being evaluated for male factor infertility of whom 33 agreed to undergo venography. MAIN OUTCOME MEASURES: Ultrasonographic measurement of scrotal vein diameter of patients in the supine and upright position, before and during valsalva maneuver, and scrotal vein blood flow reversal with valsalva maneuver was compared with the findings of varicocele by physical examination and venography. RESULTS: The best predictor of a varicocele was internal spermatic vein diameter, and the best overall performance of ultrasonography was achieved with the patient at rest in the supine position. The best cutoff point for venous diameter for a clinical varicocele was 3.6 mm and 2.7 mm for a subclinical varicocele, but the overall accuracy was only 63%. CONCLUSIONS: Confirmatory studies are needed to support the ultrasonographic diagnosis of varicoceles before considering surgical repair.