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Imaging the Infertile Male-1: Varicocele

  • Giovanni Liguori
  • Stefano Bucci
  • Carlo Trombetta
  • Boris Brkljačić
  • Michele Bertolotto
Part of the Medical Radiology book series (MEDRAD)

Abstract

Color doppler ultrasound is the imaging modality of choice to evaluate patients with varicocele. In order to assess correctly the extension of the disease and the characteristics of flow, the patient should be examined supine and while standing, at rest and during Valsalva’s maneuver. Several classification can be used to grade varicocele based on position of the dilated vessels and characteristics of flow. Besides color doppler ultrasound spectral analysis is important to assess reflux duration. Experimental studies showed that varicocele causes flow changes in the testicular flows, but investigation in men requires validation. While extratesticular varicocele is relatively common, intratesticular varicocele is rare. Abdominal masses may cause not compressible secondary varicocele. CT and MR imaging are usually not indicated for evaluation of varicocele, but this condition may be recognized in case of examinations performed for other purposes. Scintigraphy and thermography have no current clinical role, while venography is usually performed as a part of percutaneous sclerotherapy.

Keywords

Color Doppler Ultrasound Testicular Volume Spermatic Vein Internal Spermatic Vein Venous Ectasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. World Health Organization (1985) Comparison among different methods for the diagnosis of varicocele. Fertil Steril 43:575–582Google Scholar
  2. Abduljaleel PM, Al-Mulhim F, Nouman A et al (2006) Intratesticular varicocele and extratesticular varicocele in a patient with nephrotic syndrome complicated by left renal vein thrombosis. Ann Saudi Med 26:228–230PubMedGoogle Scholar
  3. Alukal JP, Zurakowski D, Atala A et al (2005) Testicular hypotrophy does not correlate with grade of adolescent varicocele. J Urol 174:2367–2370 discussion 2370PubMedCrossRefGoogle Scholar
  4. Atasoy C, Fitoz S (2001) Gray-scale and color doppler sonographic findings in intratesticular varicocele. J Clin Ultrasound 29:369–373PubMedCrossRefGoogle Scholar
  5. Aydos K, Baltaci S, Salih M et al (1993) Use of color doppler sonography in the evaluation of varicoceles. Eur Urol 24:221–225PubMedGoogle Scholar
  6. Basile-Fasolo C, Izzo PL, Canale D et al (1986) Doppler sonography, contact scrotal thermography and venography: a comparative study in evaluation of subclinical varicocele. Int J Fertil 30:62–64PubMedGoogle Scholar
  7. Beddy P, Geoghegan T, Browne RF et al (2005) Testicular varicoceles. Clin Radiol 60:1248–1255PubMedCrossRefGoogle Scholar
  8. Bhatt S, Rubens DJ, Dogra VS (2006) Sonography of benign intrascrotal lesions. Ultrasound Q 22:121–136PubMedCrossRefGoogle Scholar
  9. Biagiotti G, Cavallini G, Modenini F et al (2002) Spermatogenesis and spectral echo-colour doppler traces from the main testicular artery. BJU Int 90:903–908PubMedCrossRefGoogle Scholar
  10. Bucci S, Liguori G, Amodeo A et al (2008) Intratesticular varicocele: evaluation using grey scale and color doppler ultrasound. World J Urol 26:87–89PubMedCrossRefGoogle Scholar
  11. Callea A, Berardi B, Dilorenzo V et al (1997) Echo-color doppler in the topographic study of varicocele. Arch Ital Urol Androl 69:189–192PubMedGoogle Scholar
  12. Carlsen E, Andersen AG, Buchreitz L et al (2000) Inter-observer variation in the results of the clinical andrological examination including estimation of testicular size. Int J Androl 23:248–253PubMedCrossRefGoogle Scholar
  13. Chiou RK, Anderson JC, Wobig RK et al (1997) Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology 50:953–956PubMedCrossRefGoogle Scholar
  14. Conti E, Fasolo PP, Sebastiani G et al (2005) Color doppler sonography in the intratesticular varicocele. Arch Ital Urol Androl 77:63–65PubMedGoogle Scholar
  15. Cornud F, Belin X, Amar E et al (1999) Varicocele: strategies in diagnosis and treatment. Eur Radiol 9:536–545PubMedCrossRefGoogle Scholar
  16. Das KM, Prasad K, Szmigielski W et al (1999) Intratesticular varicocele: evaluation using conventional and doppler sonography. Am J Roentgenol 173:1079–1083Google Scholar
  17. Dee KE, Deck AJ, Waitches GM (2000) Intratesticular pseudoaneurysm after blunt trauma. Am J Roentgenol 174:1136Google Scholar
  18. DemIrbas M, Ellergezen A, BI CY et al (2001) Intratesticular varicocele treated with percutaneous embolization. Urology 58:1058PubMedCrossRefGoogle Scholar
  19. Diamond DA, Roth JA, Cilento BG et al (2004) Intratesticular varicocele in adolescents: a reversible anechoic lesion of the testis. J Urol 171:381–383PubMedCrossRefGoogle Scholar
  20. Dogra VS, Gottlieb RH, Oka M et al (2003) Sonography of the scrotum. Radiology 227:18–36PubMedCrossRefGoogle Scholar
  21. Dubin L, Amelar RD (1970) Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 21:606–609PubMedGoogle Scholar
  22. Erdogan N, Ekmekcioglu O, Baykara M (2003) Bilateral intratesticular varicocele in a patient with a history of bilateral cryptorchidism. Turk J Med Sci 33:117–119Google Scholar
  23. Eskew LA, Watson NE, Wolfman N et al (1993) Ultrasonographic diagnosis of varicoceles. Fertil Steril 60:693–697PubMedGoogle Scholar
  24. Gat Y, Zukerman ZV, Bachar GN et al (2003) Adolescent varicocele: is it a unilateral disease? Urology 62:742–746 discussion 746–747PubMedCrossRefGoogle Scholar
  25. Gat Y, Bachar GN, Zukerman Z et al (2004) Varicocele: a bilateral disease. Fertil Steril 81:424–429PubMedCrossRefGoogle Scholar
  26. Gat Y, Zukerman Z, Chakraborty J et al (2005) Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Hum Reprod 20:2614–2619PubMedCrossRefGoogle Scholar
  27. Geatti O, Gasparini D, Shapiro B (1991) A comparison of scintigraphy, thermography, ultrasound and phlebography in grading of clinical varicocele. J Nucl Med 32:2092–2097PubMedGoogle Scholar
  28. Gonda RL Jr, Karo JJ, Forte RA et al (1987) Diagnosis of subclinical varicocele in infertility. Am J Roentgenol 148:71–75Google Scholar
  29. Graif M, Hauser R, Hirshebein A et al (2000) Varicocele and the testicular-renal venous route: hemodynamic doppler sonographic investigation. J Ultrasound Med 19:627–631PubMedGoogle Scholar
  30. Grasso Leanza F, Pepe P, Panella P et al (1997) Volocimetric evaluation of spermatic vessels with echo color doppler in patients with idiopathic varicocele. Minerva Urol Nefrol 49:179–182PubMedGoogle Scholar
  31. Hargreave TB, Liakatas J (1991) Physical examination for varicocele. Br J Urol 67:328PubMedCrossRefGoogle Scholar
  32. Harrison RM, Lewis RW, Roberts JA (1983) Testicular blood flow and fluid dynamics in monkeys with surgically induced varicoceles. J Androl 4:256–260PubMedGoogle Scholar
  33. Harrison RM, Lewis RW, Roberts JA (1986) Pathophysiology of varicocele in nonhuman primates: long-term seminal and testicular changes. Fertil Steril 46:500–510PubMedGoogle Scholar
  34. Hirsh AV, Cameron KM, Tyler JP et al (1980) The Doppler assessment of varicoceles and internal spermatic vein reflux in infertile men. Br J Urol 52:50–56PubMedCrossRefGoogle Scholar
  35. Hoekstra T, Witt MA (1995) The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. J Urol 153:82–84PubMedCrossRefGoogle Scholar
  36. Hsu HS, Chang LS, Chen MT et al (1994) Decreased blood flow and defective energy metabolism in the varicocele-bearing testicles of rats. Eur Urol 25:71–75PubMedGoogle Scholar
  37. Hussein AF (2006) The role of color doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol 176:2141–2145PubMedCrossRefGoogle Scholar
  38. Jarow JP (2001) Effects of varicocele on male fertility. Hum Reprod Update 7:59–64PubMedCrossRefGoogle Scholar
  39. Liguori G, Trombetta C, Garaffa G et al (2004) Color doppler ultrasound investigation of varicocele. World J Urol 22:378–381PubMedCrossRefGoogle Scholar
  40. Liguori G, Ollandini G, Pomara G et al (2010) Role of renospermatic basal reflow and age on semen quality improvement after sclerotization of varicocele. Urology 75:1074–1078PubMedCrossRefGoogle Scholar
  41. Lund L, Nielsen AH (1994) Color doppler sonography in the assessment of varicocele testis. Scand J Urol Nephrol 28:281–285PubMedGoogle Scholar
  42. Marks JL, McMahon R, Lipshultz LI (1986) Predictive parameters of successful varicocele repair. J Urol 136:609–612PubMedGoogle Scholar
  43. Marsman JW (1985) Clinical versus subclinical varicocele: venographic findings and improvement of fertility after embolization. Radiology 155:635–638PubMedGoogle Scholar
  44. Meacham RB, Townsend RR, Rademacher D et al (1994) The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color doppler sonography. J Urol 151:1535–1538PubMedGoogle Scholar
  45. Mehta AL, Dogra VS (1998) Intratesticular varicocele. J Clin Ultrasound 26:49–51PubMedCrossRefGoogle Scholar
  46. Morvay Z, Nagy E (1998) The diagnosis and treatment of intratesticular varicocele. Cardiovasc Intervent Radiol 21:76–78PubMedCrossRefGoogle Scholar
  47. Naughton CK, Nangia AK, Agarwal A (2001) Pathophysiology of varicoceles in male infertility. Hum Reprod Update 7:473–481PubMedCrossRefGoogle Scholar
  48. Niedzielski J, Paduch D, Raczynski P (1997) Assessment of adolescent varicocele. Pediatr Surg Int 12:410–413PubMedCrossRefGoogle Scholar
  49. O’Donnell PG, Dewbury KC (1998) The ultrasound appearances of intratesticular varicocoele. Br J Radiol 71:324–325PubMedGoogle Scholar
  50. Oyen RH (2002) Scrotal ultrasound. Eur Radiol 12:19–34PubMedCrossRefGoogle Scholar
  51. Ozcan H, Aytac S, Yagci C et al (1997) Color doppler ultrasonographic findings in intratesticular varicocele. J Clin Ultrasound 25:325–329PubMedCrossRefGoogle Scholar
  52. Pearl MS, Hill MC (2007) Ultrasound of the scrotum. Semin Ultrasound CT MR 28:225–248PubMedCrossRefGoogle Scholar
  53. Petros JA, Andriole GL, Middleton WD et al (1991) Correlation of testicular color doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility. J Urol 145:785–788PubMedGoogle Scholar
  54. Ross JA, Watson NE Jr, Jarow JP (1994) The effect of varicoceles on testicular blood flow in man. Urology 44:535–539PubMedCrossRefGoogle Scholar
  55. Sakamoto H, Ogawa Y, Yoshida H (2008) Relationship between testicular volume and varicocele in patients with infertility. Urology 71:104–109PubMedCrossRefGoogle Scholar
  56. Sarteschi LM, Paoli R, Bianchini M et al (1993) Lo studio del varicocele con eco-color doppler. G Ital Ultrasonologia 4:43–49Google Scholar
  57. Sarteschi LM, Liguori G, Trombetta C (2003) Varicocele. In: Sarteschi LM, Menchini-Fabris GF (eds) Ecografia andrologica, 1st edn edn. Athena Srl, Modena, pp 139–155Google Scholar
  58. Shafik A, Moftah A, Olfat S et al (1990) Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions. Urology 35:175–182PubMedCrossRefGoogle Scholar
  59. Shiraishi K, Naito K, Takihara H (2003) Indication of varicocelectomy in the era of assisted reproductive technology: prediction of treatment outcome by noninvasive diagnostic methods. Arch Androl 49:475–478PubMedCrossRefGoogle Scholar
  60. Sigman M, Jarow JP (1997) Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. J Urol 158:605–607PubMedCrossRefGoogle Scholar
  61. Sweeney TE, Rozum JS, Desjardins C et al (1991) Microvascular pressure distribution in the hamster testis. Am J Physiol 260:H1581–H1589PubMedGoogle Scholar
  62. Tanriverdi O, Miroglu C, Horasanli K et al (2006) Testicular blood flow measurements and mean resistive index values after microsurgical and high ligation varicocelectomy. Urology 67:1262–1265PubMedCrossRefGoogle Scholar
  63. Tarhan S, Gumus B, Gunduz I et al (2003) Effect of varicocele on testicular artery blood flow in men–color doppler investigation. Scand J Urol Nephrol 37:38–42PubMedCrossRefGoogle Scholar
  64. Tasci AI, Resim S, Caskurlu T et al (2001) Color doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele. Eur Urol 39:316–321PubMedCrossRefGoogle Scholar
  65. Tetreau R, Julian P, Lyonnet D et al (2007) Intratesticular varicocele: an easy diagnosis but unclear physiopathologic characteristics. J Ultrasound Med 26:1767–1773PubMedGoogle Scholar
  66. Trum JW, Gubler FM, Laan R et al (1996) The value of palpation, varicoscreen contact thermography and colour doppler ultrasound in the diagnosis of varicocele. Hum Reprod 11:1232–1235PubMedGoogle Scholar
  67. Ünsal A, Turgut AT, Taşkin F et al (2007) Resistance and pulsatility index increase in capsular branches of testicular artery: Indicator of impaired testicular microcirculation in varicocele? J Clin Ultrasound 35:191–195PubMedCrossRefGoogle Scholar
  68. Varma MK, Ho VB, Haggerty M et al (1998) MR venography as a diagnostic tool in the assessment of recurrent varicocele in an adolescent. Pediatr Radiol 28:636–637PubMedCrossRefGoogle Scholar
  69. von Heijne A (1997) Recurrent varicocele. Demonstration by 3D phase-contrast MR angiography. Acta Radiol 38:1020–1022Google Scholar
  70. Weiss AJ, Kellman GM, Middleton WD et al (1992) Intratesticular varicocele: sonographic findings in two patients. Am J Roentgenol 158:1061–1063Google Scholar
  71. Winkelbauer FW, Ammann ME, Karnel F et al (1994) Doppler sonography of varicocele: long-term follow-up after venography and transcatheter sclerotherapy. J Ultrasound Med 13:953–958PubMedGoogle Scholar
  72. Yilmaz C, Arslan M (2009) Intrascrotal arteriovenous malformation simulating varicocele. Am J Roentgenol 192:W351CrossRefGoogle Scholar
  73. Zini A, Buckspan M, Berardinucci D et al (1997) The influence of clinical and subclinical varicocele on testicular volume. Fertil Steril 68:671–674PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Giovanni Liguori
    • 1
  • Stefano Bucci
    • 1
  • Carlo Trombetta
    • 1
  • Boris Brkljačić
    • 2
  • Michele Bertolotto
    • 3
  1. 1.Department UrologyUniversity of TriesteTriesteItaly
  2. 2.Department of Diagnostic and Interventional RadiologyDubrava University HospitalZagrebCroatia
  3. 3.Department of RadiologyUniversity of TriesteTriesteItaly

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