Hemodynamic classification of varicoceles in men: our experience
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REVIEW
Hemodynamic classification of varicoceles in men: our experience G. Iosa • D. Lazzarini
Received: 4 December 2012 / Accepted: 1 February 2013 / Published online: 30 April 2013 Ó Societa` Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2013
Abstract Aim The aim of this work is to propose a new hemodynamic classification of male varicoceles that can improve the accuracy of staging and the quality of the examination report. We retrospectively analyzed data on outpatients referred to our vascular ultrasonography service by general practitioners or urologists for work-up of ‘‘varicoceles.’’ Quantification and characterization of venous reflux is essential for selecting patients who require treatment and for evaluating the latter’s effectiveness, as demonstrated by our experience in a subgroup of 58 patients referred for imaging after surgery on endovascular procedures. Materials and methods We performed scrotal Doppler sonography on 278 males seen during the period 2009–2011 for doubts raised during clinical assessment of varicoceles or for postoperative evaluation of residual reflux. Results The diagnosis of varicocele was confirmed on 193 subjects; in 32 patients who had undergone percutaneous or surgical treatment the examination demonstrated the presence of residual reflux, while in 85 cases the presence of pain or a scrotal mass was not associated with venous reflux. Conclusions Standardized instrumental criteria have been developed for the diagnosis of varicoceles but not for their staging. The classification system we propose provides a simple, hemodynamically accurate method for qualitatively G. Iosa Medicina Interna Ospedale ‘‘Marconi’’, Cesenatico, AUSL Cesena, Cesena, Italy D. Lazzarini (&) Medicina Interna III Ospedale ‘‘A. Franchini’’, Santarcangelo di Romagna, AUSL Rimini, Rimini, Italy e-mail: [email protected]
evaluating venous reflux, and it can be a useful tool for verifying the success of surgical and endovascular procedures for correcting varicoceles. Keywords Varicocele Hemodynamic classification Doppler ultrasonography Venous reflux Pampiniform plexus Sommario Scopo Lo scopo del lavoro e` quello di proporre una nuova classificazione emodinamica che ci sembra idonea ad una corretta stadiazione del varicocele maschile ed al miglioramento della qualita` del referto dell’esame. Abbiamo effettuato l’analisi retrospettiva di una casistica ambulatoriale di pazienti afferenti al nostro servizio di ultrasonologia vascolare inviati dal medico di Medicina generale o dallo specialista Urologo col quesito ‘‘varicocele’’. La quantificazione dell’entita` e della qualita` del reflusso e` un essenziale strumento per la selezione dei Pazienti sia da avviare al trattamento, sia per la valutazione dell’efficacia del trattamento stesso, come abbiamo evidenziato in un sottogruppo di 58 pazienti giunti per controllo dopo trattamento chirurgico o endovascolare. Materiali e Metodi Abbiamo eseguito un eco-colordoppler scrotale a 278 maschi che si sono presentati nel periodo 2009–2011 per
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