MP26-13 COLOR DOPPLER ULTRASOUND IMAGING IN VARICOCELES: IS THE DIFFERENCE IN VENOUS DIAMETER ENCOUNTERED DURING VALSALVA PREDICTIVE OF PALPABLE VARICOCELE GRADE?

Abstract

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-13 COLOR DOPPLER ULTRASOUND IMAGING IN VARICOCELES: IS THE DIFFERENCE IN VENOUS DIAMETER ENCOUNTERED DURING VALSALVA PREDICTIVE OF PALPABLE VARICOCELE GRADE? Catherine Ingram*, Utsav Bansal, Adithya Balasubram, Nannan Thirumavalan, Matthew Pollard, Saneal Rajanahally, and Larry Lipshultz Catherine Ingram*Catherine Ingram* More articles by this author , Utsav BansalUtsav Bansal More articles by this author , Adithya BalasubramAdithya Balasubram More articles by this author , Nannan ThirumavalanNannan Thirumavalan More articles by this author , Matthew PollardMatthew Pollard More articles by this author , Saneal RajanahallySaneal Rajanahally More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The clinical grading system for varicoceles is subjective and dependent on clinician experience. Doppler ultrasound (US) has not been standardized in the diagnosis of varicoceles. We hypothesized that the difference between resting and Valsalva venous diameter would better correspond with palpable varicocele grade according to WHO criteria. METHODS: IRB approval was obtained for this study. Men who presented for either scrotal pain or fertility to our tertiary men’s health clinic underwent physical examination, and varicoceles were graded following WHO criteria (0 = subclinical, I, II, and III). Color Doppler US was used in the supine position to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver. Wilcoxon signed-rank test was used to compare right to left-sided venous diameters. Receiver operator characteristic (ROC) curve analysis was used to determine if resting diameter, diameter during Valsalva, or change in diameter between rest and Valsalva provided the highest sensitivity and specificity for determining clinical grade with US. Threshold values for diameter were determined from these ROC curves. RESULTS: A total of 104 men (51 with clinical varicocele and 53 with subclinical varicocele) were included in the analysis. Diameter at rest was the best ultrasonographic discriminator between subclinical and clinical varicoceles (AUC = 0.67) with a diameter threshold of 3 mm (sensitivity 79%, specificity 42%; Fig. 1). Diameter during Valsalva had the greatest AUC for determining clinical grades 1 versus 2 (AUC = 0.57) with diameter threshold of 5.7 mm (sensitivity 71%, specificity 33%). For differentiating between grades 2 and 3, diameter at rest had the greatest AUC of 0.65 with a threshold of 3.6 mm (sensitivity 71%, specificity 58%). CONCLUSIONS: Our results show a correlation between US and clinical grading. The use of Valsalva was less predictive than diameter at rest and was only clinically significant in differentiating between Grade I and II varicocele. A standardized method for determining clinically relevant varicoceles on US would allow for improved patient counseling and clinical decision-making. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e405-e405 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Ingram* More articles by this author Utsav Bansal More articles by this author Adithya Balasubram More articles by this author Nannan Thirumavalan More articles by this author Matthew Pollard More articles by this author Saneal Rajanahally More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement PDF downloadLoading ...