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Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele?

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Abstract

Purpose

Investigating the diagnostic value of color Doppler ultrasound for defining the varicocele grade according to WHO criteria.

Methods

A total of 217 men (129 with clinical varicocele and 88 without clinical varicocele) were investigated by physical examination and color Doppler ultrasound and categorized according to WHO varicocele criteria (0, subclinical, I, II, and III). Diameter and reflux of the largest vein in the pampiniform plexus were measured bilaterally with the patient in the supine position in rest and during the Valsalva maneuver. To assess the possibility of differentiating varicocele grade by venous diameter, optimal cut-point values were determined by receiver-operator characteristic (ROC) analysis.

Results

With increased varicocele grade, a larger vein diameter was more significant in rest and during Valsalva (in all cases P < 0.05), except between grade I and grade II. Retrograde peak flow velocities were similar in every group (in all cases P > 0.1). Only grade III varicoceles demonstrated significantly increased peak flow values compared with all other grades (P < 0.001). There were no side-related differences when comparing identical varicocele grades (in all cases P > 0.1). Venous diameters above 2.45 mm in rest (sensitivity 84%, specificity 81%) or 2.95 mm during Valsalva (sensitivity 84%, specificity 84%) predicted the presence of a clinical varicocele.

Conclusions

Our findings support the hypothesis that clinical varicoceles can be predicted with high accuracy based only on the diameter of testicular veins using cut-point values of >2.45 mm in rest or >2.95 mm during Valsalva maneuver in the supine position.

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Abbreviations

CDU:

Color Doppler ultrasound

ROC:

Receiver-operator characteristic

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Conflict of interest

The present authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Pediatric Urology and Andrology, University Hospital Giessen and Marburg GmbH—Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35385, Giessen, Germany

    A. Pilatz, B. Altinkilic, E. Köhler, M. Marconi & W. Weidner

  2. Urology Unit, Complejo Hospitalario San Jose, Santiago, Chile

    M. Marconi

Authors
  1. A. Pilatz
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  2. B. Altinkilic
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  3. E. Köhler
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  4. M. Marconi
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  5. W. Weidner
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Corresponding author

Correspondence to A. Pilatz.

Additional information

A. Pilatz, B. Altinkilic contributed in equal parts.

M. Marconi was a fellow in “Clinical Andrology” at the Department of Urology in Giessen (2007–2008), Scholarship MIDEPLAN Chile.

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Pilatz, A., Altinkilic, B., Köhler, E. et al. Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele?. World J Urol 29, 645–650 (2011). https://doi.org/10.1007/s00345-011-0701-4

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  • DOI: https://doi.org/10.1007/s00345-011-0701-4

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