Determination of the best position and site for color Doppler ultrasonographic evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically

Background: There are no generally accepted criteria for the ultrasonographic diagnosis and grading of varicocele. We aimed to determine the best position and site for color Doppler ultrasonographic (CDUS) evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically. Materials and Methods: This study consisted of 103 men (44 normal and 59 with clinical varicocele). First, WHO clinical grade of varicocele was determined by physical examination. Then, the diameter of largest testicular vein at four different sites was measured in both upright and supine positions with or without Valsalva maneuver. Finally, the cut-off points of venous diameter for different clinical grades were determined using the values of the position and sites that had the strongest correlation with the clinical grades. Results: The strongest correlation between venous diameter and clinical grade of varicocele was observed when the venous diameter was measured at the level of epididymal head in the upright position with Valsalva maneuver (r: 0.87, P-value < 0.0001). In aforementioned conditions, venous diameter of 2.35 mm (sensitivity 87%, specificity 87%) can distinguish normal subjects from grade 1 varicocele, venous diameter of 3.15 mm (sensitivity 58%, specificity 70%) can discriminate grade 1 from grade 2, and venous diameter of 3.75 mm (sensitivity 83%, specificity 70%) can differentiate grade 2 from grade 3. Furthermore, venous diameter of 2.65 mm (sensitivity 91%, specificity 89%) can distinguish normal subjects from patients with clinical varicocele. Conclusion: The best position for CDUS examination of patients suspected of having varicocele is the upright position with Valsalva maneuver, and the best site for venous diameter measurement is at the level of epididymal head