Color Doppler Ultrasonographic Evaluation of Varicocele Best Position and Site for Improving Maximal Vein Diameter Measurement

Jul 8, 2026

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The study determines the optimal patient position and scanning site for color Doppler ultrasonography of the testicular vein to achieve the most accurate maximal vein diameter measurement. Eighty-nine men (22–48 years) with confirmed varicocele were evaluated during the first half of 2017. Maximal vein diameter was measured at three sites in both supine and standing positions, with and without Valsalva. The posterolateral scrotal edge in the upright position with Valsalva produced the largest diameter, followed by the epididymal head level. Varicoceles were graded using supine-rest maximum diameter for comparison.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

Abstract

Introduction

Patients and methods

Color Doppler Ultrasonographic Evaluation of Varicocele: Best Position and Site for Improving Maximal Vein Diameter Measurement Jamal Omer Bahabara* Wadea Saeed Bin Ghouth* Abstract The purpose of this study is to identify the best position and site for color Doppler ultrasonography evaluation of testicular vein to obtain optimal diameter measurement. Over the first six months of year 2017, eighty nine patients aged 22-48 years who proved to have varicocele were included in the study. Color Doppler sonography was performed using a 7.5 MHz linear-array transducer, and the diameter of largest testicular vein at three different sites was measured in both supine and standing positions with and without Valsalva maneuver. Patients' varicoceles were graded according to the supine-rest maximum vein diameter into: Grade 0: less than 2 mm, Grade I: 2-3 mm, Grade II: more than 3 mm, and the changes in caliber in those grades were compared. Posterlateral scrotal edge was the best site for maximal vein diameter measurement followed by epididymal head, and the maximum vein diameter is obtained at the standing position with the use od Valsalva maneuver. So, the best position and site was the upright position with Valsalva maneuver at the posterolateral scrotal edge followed by epididymal head level. Key wards: Color Doppler ultrasonography, Valsalva maneuver, Varicocele. Introduction: Varicocele is a collection of abnormally dilated, tortuous spermatic veins [3,8] . They occur with an incidence of 15% in adolescent males and 10– 15% in adult men [21] . The clinical relevance of varicocele is based on its symptoms being related to scrotal venous stasis and the potential association with male infertility. Varicocele is recognized as the most common surgically correctable cause of male infertility (30), but the exact mechanism of varicoceleinduced impairment of spermatogenesis remains a matter of debate [23] . The exact association between reduced male fertility and varicocele is unknown, but studies showed that semen improvement is usually observed after surgical correction [6,7,24, 27,34] . Varicoceles are often classified as clinical or subclinical. Clinical varicoceles are diagnosed by physical examination and are graded based on physical findings according to Dubin and Amelar (1970) into three grades [1], while subclinical varicoceles are those that are not palpable on physical examination and require imaging for diagnosis by the presence of US findings of venous dilation and/or reflux flow in thepampiniform plexus [20,29] . So, physical examination is an essential diagnostic tool, but alone is not a highly reliable tool, and is affected by low sensitivity and specificity, especially in cases of low grade or subclinical varicocele [4,13, 17], although current evidence indicates * Department of surgery (radiology) -College of medicine and health sciences- Hadramout University - Mukalla-Yemen. Received on 20/11/2017 and Accepted for Publication on 17/4/2018 that treatment of subclinical varicocele is not warranted, as it does not seem to improve fertility [32] . Color Doppler ultrasonography (CDUS) is the most sensitive, non-invasive and world-wide diagnostic method for varicocele, and has a sensitivity of approximately 95% in the diagnosis of varicocele [19] . In addition, CDUS may be apart of early postoperative follow-up as well as preoperative examination for predicting varicocelectomy outcome, especially for macroscopic surgeries [2,9, 11,12] . In the other hand, color Doppler is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele, regarding World Health Organization (WHO) 2000 guidelines on male infertility which state that avaricocele diagnosis should be confirmed by color Doppler [15] . Although the maximal vein diameter and the presence, velocity, and duration of reflux are the currently used criteria for diagnosis of varicocele, but the quantitative measures

FAQs

Which position and scanning site gave the largest maximal vein diameter measurement?

The upright (standing) position combined with the Valsalva maneuver at the posterolateral scrotal edge produced the maximum vein diameter, followed by the epididymal head level.

Jul 8, 2026

Upload by Violet