You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD29)1 Sep 2021PD29-08 IS CURRENT DEFINITION OF SUBCLINICAL VARICOCELE RELIABLE? Safar Gamidov, Taras Shatylko, Alina Popova, Natig Gasanov, and Timur Bitsoev Safar GamidovSafar Gamidov More articles by this author , Taras ShatylkoTaras Shatylko More articles by this author , Alina PopovaAlina Popova More articles by this author , Natig GasanovNatig Gasanov More articles by this author , and Timur BitsoevTimur Bitsoev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002030.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a general consensus today that subclinical varicocele should not be treated, which is reflected in current guidelines. However, this term originates from 1979 article by Greenberg et al., where it was defined as non-palpable varicocele detected by Doppler ultrasonography, which was a novel technology back then. As such, this definition of subclinical varicocele, which basically relies on palpation, may be outdated and in need of revision. METHODS: We performed a prospective analysis of 138 consecutive patients who underwent scrotal ultrasonography by a single specialist (T.S.) in 2020 as a part of fertility evaluation. Patients previously treated for varicocele were excluded from this study. Prior to ultrasonography all patients underwent physical examination, and detailed description of palpation findings and medical history was stored in an electronic database. Scrotal veins were measured bilaterally both in supine and standing positions and checked for reflux during Valsalva maneuver. Varicocele, if found, was graded according to classification by Sarteschi et al. [1993] Ultrasound operator was blinded to the previously recorded palpation findings. We evaluated the concordance between palpation and ultrasonography results. RESULTS: Sixty-seven patients (48.5%) had physical findings suggestive of varicocele. Overall incidence of varicocele confirmed by ultrasound evaluation was 63% (87 / 138). Interestingly, 15 patients (10.9%) had «palpable veins» on physical examination, but no evidence of varicocele on scrotal ultrasound, as other contents of spermatic cord (such as cremasteric fibers contracting during Valsalva maneuver) could be mistakenly identified as veins during palpation. Thirty-five (25.3%) patients had non-palpable varicocele which was identified on ultrasound only. According to Sarteschi classification, 10 of them had grade I varicocele (without dilation per se), 20 had grade II varicocele, 3 had grade III, and 1 patient each had grade IV and V. Median diameter of scrotal veins was 3.1 mm and 3.4 mm in patients with non-palpable and palpable varicocele, respectively (median: 3.4 mm; Mann-Whitney U-test: p=0.033). Patients with non-palpable varicocele had numerous factors which could have hindered palpation, such as obesity (n=17), history of scrotal or inguinal surgery (n=5), retractile testes (n=2) and isolated gubernacular varicocele without dilation of spermatic cord vessels (n=5). CONCLUSIONS: There is a high rate of discrepancy between palpation and ultrasonography in work-up of varicocele in infertile patients. Not only the physical examination is subjective and operator-dependent, there are also conditions which hinder proper identification of scrotal varicosities during palpation. Considering this, the decision to operate probably should not rely on palpation and the current definition of subclinical varicocele. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e529-e530 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Safar Gamidov More articles by this author Taras Shatylko More articles by this author Alina Popova More articles by this author Natig Gasanov More articles by this author Timur Bitsoev More articles by this author Expand All Advertisement Loading ...
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