Varicocele: strategies in diagnosis and treatment

Varicocele can be very easily diagnosed by physical examination and subsequ ently treated when it is painful or associated with testicular hypotrophy. However, palpability of the spermatic vein and reflux in low grade or even questionable varicoceles can be difficult to assess without imaging modalit ies. This can be a common problem for all physicians treating hypofertile m en to decide whether the varicele needs to be treated or not. However, a go ld standard that defines the presence of a subclinical varicocele has not y et been established. The different diagnostic tools based on ultrasonograph y investigated these past years to define a flow reversal in incontinent sp ermatic veins are presented in the first part of this review, with emphasis on subclinical varicocele. In the second part, we present our experience, together with a review of the literature concerning embolization of the spe rmatic veins as an alternative to surgery to treat varicoceles.