Varicocele: ultrasonographic assessment in daily clinical practice

Sommario INTRODUZIONE: Il varicocele è un’anomala dilatazione del plesso pampiniforme; in base all’eziologia può essere distinto in primitivo e secondario, mentre in base all’estensione e alla presenza o assenza di reflussi, spontanei o provocati, può essere classificato in stadi. MATERIALI E METODI: Sono stati inclusi nello studio 95 pazienti con età compresa tra 3 e 77 anni. I parametri color Doppler sono stati ottimizzati per la valutazione dei flussi lenti. In tutti i pazienti con varicocele è stato eseguito un esame ecografico di reni e retroperitoneo. Per la classificazione è stata utilizzata quella di Sarteschi, semplificata. RISULTATI: I casi di varicocele riscontrati sono stati 41 (43,1%); in base alla classificazione di Sarteschi semplificata 11 pazienti rientravano nel grado 1; 13 nel grado 2; 10 nel grado 3; 7 nel grado 4. DISCUSSIONE: I risultati da noi rilevati sono simili a quelli presenti in letteratura, si conferma quindi come il varicocele sia frequente e al momento attuale l’ecografia rappresenti la tecnica di imaging di elezione nello studio di questa affezione, sia per la diagnosi che per il follow-up post-intervento. L’associazione con l’infertilità resta di pertinenza dello spermiogramma.INTRODUCTION: Varicoceles are abnormal dilatations of the pampiniform venous plexus. They are classified as primary or secondary, depending on their cause, and staged clinically on the basis of their extension and on the presence or the absence of spontaneous or induced reversal of blood flow. MATERIALS AND METHODS: We examined 95 patients (age range: 3-77 years) using Color Doppler ultrasound with settings optimized for the study of slow flow. All patients found to have varicoceles underwent ultrasonographic assessment of the kidneys and retroperitoneum. Findings were classified with a simplified version of the Sarteschi system. RESULTS: 41 (43.1%) of the patients were found to have varicoceles, which were classified as grade 1 in 11 cases, grade 2 in 13, grade 3 in 10, and grade 4 in 7 according to the simplified Sarteschi classification. DISCUSSION: Our results are with those reported in the literature. They confirm that varicoceles are a frequent finding and ultrasonography is currently the best imaging technique for its diagnosis and also for the post-surgery follow-u

Varicocoele. Classification and pitfalls

Background Varicocoeles have been considered for a long time potentially correctable causes for male infertility, even though the correlation of this condition with infertility and sperm damage is still debated.Objective To present a summary of the evidence evaluation for imaging varicocoeles, to underline the need for a standardized examination technique and for a unique classification, and to focus on pitfalls in image interpretation.Methods Based on the evidence of the literature, the current role of ultrasound (US) imaging for varicocoeles has been reported and illustrated, with emphasis on examination technique, classification, and pitfalls.Results US is the imaging modality of choice. It is widely used in Europe, while in other countries clinical classification of varicocoeles is considered sufficient to manage the patient. A number of US classifications exist for varicocoeles, in which the examinnation is performed in different ways.Discussion An effort toward standardization is mandatory, since lack of standardization contributes to the confusion of the available literature, and has a negative impact on the understanding of the role itself of imaging in patients with varicocoeles.Conclusion Use of the Sarteschi/Liguori classification for varicocoeles is recommended, since it is the most complete and widely used US scoring system available today.Tubular extratesticular structures resembling varicocoeles, either at palpation or at US, should be identified and correctly characterized