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Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading

  • Simon FreemanEmail author
  • Michele Bertolotto
  • Jonathan Richenberg
  • Jane Belfield
  • Vikram Dogra
  • Dean Y. Huang
  • Francesco Lotti
  • Karolina Markiet
  • Olivera Nikolic
  • Subramaniyan Ramanathan
  • Parvati Ramchandani
  • Laurence Rocher
  • Mustafa Secil
  • Paul S. Sidhu
  • Katarzyna Skrobisz
  • Michal Studniarek
  • Athina Tsili
  • Ahmet Tuncay Turgut
  • Pietro Pavlica
  • Lorenzo E. Derchi
  • members of the ESUR-SPIWG WG
Urogenital

Abstract

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.

Key Points

• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility.

• Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification.

• This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.

Keywords

Varicocele Scrotum Infertility, male Ultrasonography Ultrasonography, Doppler 

Abbreviations

AGREE

Appraisal of Guidelines for Research and Evaluation

AVMs

Arteriovenous malformations

ESUR

European Society of Urogenital Radiology

GRADE

Grading of Recommendations Assessment, Development and Evaluation

H

Height

L

Length

OCEBM

Oxford Centre for Evidence Based Medicine

PICO

Patient Problem (or Population), Intervention, Comparison or Control, Outcome

Sec

Seconds

SPIWG

Scrotal and Penile Imaging Working Group

V

Volume

W

Width

WG

Guideline writing group

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Simon Freeman on behalf of the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this paper provides a summary of available evidence and expert opinion; no new studies on patients were involved.

Ethical approval

Institutional Review Board approval was not required because this is an evidence summary and expert recommendation paper. No new studies on human patients were undertaken specifically for this paper.

Study subjects or cohorts overlap

All previous studies cited as evidence in this paper are acknowledged in the references.

Methodology

• Multicentre authored paper on behalf of the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG). Literature review, evidence summary, and expert recommendations.

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Simon Freeman
    • 1
    Email author
  • Michele Bertolotto
    • 2
  • Jonathan Richenberg
    • 3
  • Jane Belfield
    • 4
  • Vikram Dogra
    • 5
  • Dean Y. Huang
    • 6
  • Francesco Lotti
    • 7
  • Karolina Markiet
    • 8
  • Olivera Nikolic
    • 9
  • Subramaniyan Ramanathan
    • 10
  • Parvati Ramchandani
    • 11
  • Laurence Rocher
    • 12
    • 13
  • Mustafa Secil
    • 14
  • Paul S. Sidhu
    • 6
  • Katarzyna Skrobisz
    • 8
  • Michal Studniarek
    • 8
  • Athina Tsili
    • 15
  • Ahmet Tuncay Turgut
    • 16
  • Pietro Pavlica
    • 17
  • Lorenzo E. Derchi
    • 18
  • members of the ESUR-SPIWG WG
  1. 1.University Hospitals Plymouth NHS TrustDerriford HospitalPlymouthUK
  2. 2.Department of Radiology, Ospedale di CattinaraUniversity of TriesteTriesteItaly
  3. 3.Brighton and Sussex University Hospitals NHS TrustRoyal Sussex County HospitalBrightonUK
  4. 4.Royal Liverpool University HospitalLiverpoolUK
  5. 5.Department of RadiologyUniversity of RochesterRochesterUSA
  6. 6.King’s College Hospital NHS Foundation Trust, Department of RadiologyKing’s College HospitalLondonUK
  7. 7.Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical SciencesUniversity of FlorenceFlorenceItaly
  8. 8. Department of RadiologyMedical University of GdanskGdanskPoland
  9. 9.Faculty of Medicine, Center of Radiology, Clinical Center of VojvodinaUniversity of Novi SadNovi SadSerbia
  10. 10.Department of Clinical Imaging, Weill Cornell Medical College, Al-Wakra HospitalHamad Medical CorporationDohaQatar
  11. 11.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  12. 12.Department of Adult Diagnostic and Interventional RadiologyBicetre University HospitalLe Kremlin BicêtreFrance
  13. 13.Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081Service Hospitalier Frédéric JoliotOrsay CedexFrance
  14. 14.Faculty of Medicine, Department of RadiologyDokuz Eylul UniversityIzmirTurkey
  15. 15.Department of Clinical Radiology, Medical SchoolUniversity of IoanninaIoanninaGreece
  16. 16.Department of Radiology, Faculty of MedicineIstinye UniversityIstanbulTurkey
  17. 17.Private Hospital S.M. MaddalenaRovigoItaly
  18. 18.Department of Health Sciences (DISSAL), Emergency RadiologyUniversity of GenoaGenoaItaly

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