ULTRASONOGRAPHIC DIAGNOSIS OF VARICOCELES

Objective: To assess the ability of color duplex scrotal ultrasonograp hy to detect subclinical varicoceles and confirm the diagnosis of clin ical varicoceles. Design: Physical examination, color duplex scrotal u ltrasonography and internal spermatic venography was performed on 64 t esticular units in 33 men. Setting: Male fertility center. Patients: T wo hundred sixty-two consecutive men being evaluated for male factor i nfertility of whom 33 agreed to undergo venography. Main Outcome Measu res: Ultrasonographic measurement of scrotal vein diameter of patients in the supine and upright position, before and during valsalva maneuv er, and scrotal vein blood flow reversal with valsalva maneuver was co mpared with the findings of varicocele by physical examination and ven ography. Results: The best predictor of a varicocele was internal sper matic vein diameter, and the best overall performance of ultrasonograp hy was achieved with the patient at rest in the supine position. The b est 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 surgi cal repair.