madman
Super Moderator
Abstract
Background: Varicoceles have been considered for a long time as 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 varicoceles, 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 US imaging for varicoceles 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 varicoceles is considered sufficient to manage the patient. A number of US classifications exist for varicoceles, in which the exam is performed in different ways.
Discussion: An effort towards 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 varicoceles.
Conclusion: The use of the Sarteschi/Liguori classification for varicoceles is recommended since it is the most complete and widely used US scoring system available today.
*Tubular extratesticular structures resembling varicoceles, either at palpation or at US, should be identified and correctly characterized.
Introduction
Varicoceles are abnormal dilatations of the pampiniform plexus with reflux of venous blood flow. It is present in 15% of the general male population, but it is more often identified in patients seeking medical attention for infertility 1, 2. This is why varicoceles have been considered for a long time as potentially correctable causes for male infertility. However, a recent multicentric international study promoted by the European Academy of Andrology 3, 4 reported in healthy, fertile men a prevalence of varicoceles (~37%) similar to that reported in primary infertile men 5–7. These data suggest that varicocele may exert a scanty effect on male fertility and that its surgical correction should be limited to highly selected populations. Accordingly, current EAU Guidelines on Male Infertility support nowadays very specific indications for varicocele treatment both in adults and adolescents 8.
US is the imaging modality of choice for varicoceles 8. The body of published investigations is large but exceedingly heterogeneous, and the role of imaging itself in the management of these patients is debated 9, 10. Outside Europe, US is not routinely used. Most important, both in and outside Europe US is performed in different ways, and several classifications are used 2.
Recently, ESUR-SPIWG - the Scrotal and Penile Imaging Working group of the European Society of Urogenital Radiology - released two papers to promote standardization of US for varicoceles 5, 6. Recommendations are based on the evidence of the available literature and, when evidence is lacking, on best clinical practice and expert opinion. In these two papers, the most important features to consider when investigating a patient for varicoceles are discussed, how to perform the US examination, and which classification is best.
*Clinical classification of varicoceles
*US Classification of varicoceles
*How to perform US examination for varicoceles
*Testicular volume
*Presence, duration, and characteristics of reflux
*Reflux peak velocity
*Testicular and extratesticular abnormalities
*Reporting
*Pitfalls
Conclusions
Although they are often asymptomatic and detected incidentally, varicoceles are considered potentially correctable causes for male infertility. Diagnosis is obtained at US, but standardization is necessary since there is no consensus on the diagnostic criteria, classification, and examination technique. The Sarteschi/Liguori classification is the most complete and widely used scoring system available today. Cysts, spermatoceles, tubular ectasia, post-vasectomy changes, and other conditions which can mimic clinically varicoceles are differentiated with multiparametric US.
Background: Varicoceles have been considered for a long time as 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 varicoceles, 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 US imaging for varicoceles 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 varicoceles is considered sufficient to manage the patient. A number of US classifications exist for varicoceles, in which the exam is performed in different ways.
Discussion: An effort towards 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 varicoceles.
Conclusion: The use of the Sarteschi/Liguori classification for varicoceles is recommended since it is the most complete and widely used US scoring system available today.
*Tubular extratesticular structures resembling varicoceles, either at palpation or at US, should be identified and correctly characterized.
Introduction
Varicoceles are abnormal dilatations of the pampiniform plexus with reflux of venous blood flow. It is present in 15% of the general male population, but it is more often identified in patients seeking medical attention for infertility 1, 2. This is why varicoceles have been considered for a long time as potentially correctable causes for male infertility. However, a recent multicentric international study promoted by the European Academy of Andrology 3, 4 reported in healthy, fertile men a prevalence of varicoceles (~37%) similar to that reported in primary infertile men 5–7. These data suggest that varicocele may exert a scanty effect on male fertility and that its surgical correction should be limited to highly selected populations. Accordingly, current EAU Guidelines on Male Infertility support nowadays very specific indications for varicocele treatment both in adults and adolescents 8.
US is the imaging modality of choice for varicoceles 8. The body of published investigations is large but exceedingly heterogeneous, and the role of imaging itself in the management of these patients is debated 9, 10. Outside Europe, US is not routinely used. Most important, both in and outside Europe US is performed in different ways, and several classifications are used 2.
Recently, ESUR-SPIWG - the Scrotal and Penile Imaging Working group of the European Society of Urogenital Radiology - released two papers to promote standardization of US for varicoceles 5, 6. Recommendations are based on the evidence of the available literature and, when evidence is lacking, on best clinical practice and expert opinion. In these two papers, the most important features to consider when investigating a patient for varicoceles are discussed, how to perform the US examination, and which classification is best.
*Clinical classification of varicoceles
*US Classification of varicoceles
*How to perform US examination for varicoceles
*Testicular volume
*Presence, duration, and characteristics of reflux
*Reflux peak velocity
*Testicular and extratesticular abnormalities
*Reporting
*Pitfalls
Conclusions
Although they are often asymptomatic and detected incidentally, varicoceles are considered potentially correctable causes for male infertility. Diagnosis is obtained at US, but standardization is necessary since there is no consensus on the diagnostic criteria, classification, and examination technique. The Sarteschi/Liguori classification is the most complete and widely used scoring system available today. Cysts, spermatoceles, tubular ectasia, post-vasectomy changes, and other conditions which can mimic clinically varicoceles are differentiated with multiparametric US.
