Color Doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele

Objective: The standardization of diagnostic criteria for varicocele has no t yet been established. This causes difficulty in evaluating both the incid ence and clinical studies. Our aim was to establish diagnostic criteria for varicocele in Doppler procedures. Methods: The characteristics of blood flow in the internal spermatic vein w ere investigated with color Doppler ultrasonography (CDU) and venous flow s pectral analysis in 100 infertile men without clinical varicocele (group I) , 100 infertile men with clinical left varicocele (group II), and 50 fertil e men without clinical varicocele served as controls (group III). Results: Th ree types of flow pattern were found in the spectra I analysis of venous flow. If the venous flow was directed to the heart and did not ch ange direction with an intra-abdominal pressure increase, it was classified as type I; venous flow directed to the heart, but changing direction with an intra-abdominal pressure increase, was classified as type II, and blood flow directed to the testicles and augmenting with an intra-abdominal press ure increase, was classified as type III. In group I, flow patterns were 39 , 56 and 5% on the left side and 55, 42 and 3% on the right side for types I. II and III, respectively. In group If, flow patterns were 0, 35 and 65% on the left side and 61, 38 and 1% on the right side for type I, II and III patterns, respectively. In group III, the figures were 44, 54 and 2% for t he left and 54, 46 and 0% for the right. Type II and III flow patterns were seen more frequently than type I in patients with clinical left varicocele (p<0.001). Whereas type I and II flow patterns were more common than type III in subjects without clinical varicocele (p<0.05). A type II flow patter n during normal breathing was seen at a lower rate in the control group tha n in the other groups (p<0.05). Conclusion: Spectral analysis of Doppler waves should be used in combinatio n with CDU for the diagnosis of varicocele. Varicocele should not only be d iagnosed with a type II flow pattern which occurs during valsalva. For the diagnosis of varicocele, the main criterion must be a type III pattern flow , as well as a type II pattern during normal breathing. Copyright <(c)> 200 1 S. Karger AG, Basel.