Varicocele
Varicocele is clinically defined as an abnormal dilatation of the veins of the pampiniform plexus with continuous or intermittent reflux of the venous blood. It is actually considered the most common correctable cause of male infertility, even though the
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Varicocele Giovanni Liguori, Gaetano Chiapparrone, Stefano Bucci, Francesca Vedovo, Nicola Pavan, Carlo Trombetta, and Michele Bertolotto
42.1 Introduction
42.2 Classification of Varicocele
Varicocele is clinically defined as an abnormal dilatation of the veins of the pampiniform plexus with continuous or intermittent reflux of the venous blood. It is actually considered the most common correctable cause of male infertility, even though the mechanisms responsible for infertility are still unclear. The prevalence of this disorder in the general population is approximately 15–20 % [1], and it is involved in up to 40 % of cases of men infertility [2–4].
Varicocele is assessed and graded clinically using the criteria introduced by Dubin and Amelar [5] (Table 42.1), but this evaluation is highly subjective and strongly depends on the expertise of the physician [6] since dartos hyperactivity and contraction of the cremaster muscle induced by palpation or Valsalva maneuver may mimic or mask testicular venous distension [7]. The subjectivity of the clinical grading for varicocele is confirmed by Hargreave and Liakatas [8], who found disagreement in 26 % of patients examined by two experienced clinicians, and by a multicenter study on 141 subfertile men sponsored by the World Health Organization [9], which showed that compared with venography clinical assessment of varicocele was approximately 50 % sensitive, with a false-positive rate of 23 %. Using color Doppler ultrasound, Niedzielski et al. found reflux in only 39 % of patients in whom varicocele was suspected on clinical evaluation [10]. Since clinical diagnosis and grading of varicocele is limited, several imaging methods have been introduced to evaluate this disease, including gray-scale and color Doppler ultrasound. Color Doppler ultrasound is currently the imaging modality of choice. The only gold standard in varicocele’s diagnosis is retrograde phlebography of the spermatic veins, but it is not adequate as a routine screening test. The most applied US classification in daily practice is the one proposed by Sarteschi et al.
Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-319-40782-1_42) contains supplementary material, which is available to authorized users. G. Liguori, MD, PhD (*) • G. Chiapparrone, MD • S. Bucci, MD • F. Vedovo, MD • C. Trombetta, MD Department Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, Trieste 34124, Italy e-mail: [email protected] N. Pavan Department of Medical, Surgical and Health Science, Urology Clinic, University of Trieste, Strada di Fiume, 447, Trieste 34149, Italy e-mail: [email protected] M. Bertolotto, MD Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, Trieste 34124, Italy
© Springer International Publishing Switzerland 2017 P. Martino, A.B. Galosi (eds.), Atlas of Ultrasonography in Urology, Andrology, and Nephrology, DOI 10.1007/978-3-319-40782-1_42
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512 Table 42.1 Dubin and A
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