Ann Urol Res | Volume 1, Issue 1 | Research Article | Open Access
Arunan Sujenthiran1*, Saad Abumelha2,3, Tet Yap1,2, Fahad Al Mashat2, Alex Kirkham4, Miles Walkden4 and Suks Minhas2
1Department of Urology, St. George’s Hospital and Medical School, UK
2Department of Urology, University College Hospital, UK
3Department of Surgery, Division of Urology, King Abdulaziz Medical City, Saudi Arabia
4Department of Radiology, University College Hospital, UK
*Correspondance to: Arunan Sujenthiran
Fulltext PDFPurpose: There are no diagnostic recommendations for the evaluation of men prior to therapeutic intervention for clinical varicoceles. The aim of this study was to define a simple and reliable hemodynamic parameter predicting the presence of reflux in clinical varicoceles (grade II/III) compared to the gold-standard of venography.
Methods: Data were retrospectively collected on men presenting to a tertiary referral center with subfertility/infertility, testicular pain or palpable mass over an 11-year period (2004-2015). Men with clinical varicoceles (defined as grade II/III) underwent color doppler ultrasound (CDU) and maximum venous diameter (MVD) was measured and correlated to reflux at venography, at the time of therapeutic embolization. Receiver-operator characteristic analyses identified the threshold MVD to detect reflux.
Results: A total of 107 men (70 unilateral, 37 bilateral) underwent CDU. From all, 144 testis units were included with a mean MVD of 3.5 mm (range 2 mm to 7 mm). CDU-reflux is demonstrated in 108 of 144 (75.0%) testes and 97 testes underwent venography of which 73 (75.3%) had demonstrable reflux. MVD in testes with venography-detected reflux was 4.0 mm (range 2 mm to 7 mm) compared to 2.7 mm (range 2 mm to 4 mm) in those without reflux (p<0.01). The optimal MVD for discriminating men with and without venography-diagnosed reflux was 3.0 mm (sensitivity-95.9%, specificity-58.3%, correctly-classified 86.6%, AUC=0.86). MVD ≥ 3 mm was a more accurate discriminator for identifying patients with venography-reflux compared to CDUreflux alone (correctly-classified 82.5%, AUC=0.73). Conclusions: A threshold value MVD ≥ 3 mm accurately identifies more men with proven venography-reflux than using CDU-detected reflux. MVD is a simple parameter that can be used to stratify men with clinical varicoceles, who may benefit from therapeutic intervention.
Varicocele; Testes; Reflux; Ultrasonography; Doppler
Sujenthiran A, Abumelha S, Yap T, Al Mashat F, Kirkham A, Walkden M, et al. Maximum Venous Diameter is a Simple and Objective Measurement to Characterize Clinical Varicoceles. Ann Urol Res. 2017; 1(1): 1003.