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Varicocele: strategies in diagnosis and treatment
1Service de Radiologie, Hôpital Necker, 149 rue de Sèvres, F-75015 Paris, France.
Insights
Diagnosing subclinical varicoceles is challenging. This review explores ultrasonography for detecting flow reversal in spermatic veins and discusses embolization as a treatment alternative to surgery for male infertility.
Area of Science:
- Reproductive Medicine
- Urology
- Medical Imaging
Background:
- Varicocele, a common cause of male infertility, is often diagnosed via physical examination.
- Assessing low-grade or questionable varicoceles can be difficult without imaging, complicating treatment decisions for hypofertile men.
- A definitive gold standard for diagnosing subclinical varicocele remains elusive.
Purpose of the Study:
- To review diagnostic tools, particularly ultrasonography, for identifying subclinical varicoceles.
- To emphasize the detection of flow reversal in incontinent spermatic veins.
- To present experiences and literature on spermatic vein embolization as a treatment alternative.
Main Methods:
- Review of diagnostic ultrasonography techniques for varicocele assessment.
- Analysis of flow reversal in spermatic veins using imaging modalities.
- Literature review and presentation of clinical experience with spermatic vein embolization.
Main Results:
- Ultrasonography offers various methods to detect flow reversal, aiding in subclinical varicocele diagnosis.
- Subclinical varicoceles present diagnostic challenges due to difficulties in palpation and assessment.
- Spermatic vein embolization is presented as a viable alternative to surgical treatment for varicoceles.
Conclusions:
- Accurate diagnosis of subclinical varicocele is crucial for effective infertility management.
- Ultrasonography plays a key role in identifying subtle varicoceles.
- Embolization offers a minimally invasive option for varicocele treatment.
Abstract:
Varicocele can be very easily diagnosed by physical examination and subsequently treated when it is painful or associated with testicular hypotrophy. However, palpability of the spermatic vein and reflux in low grade or even questionable varicoceles can be difficult to assess without imaging modalities. This can be a common problem for all physicians treating hypofertile men to decide whether the varicele needs to be treated or not. However, a gold standard that defines the presence of a subclinical varicocele has not yet been established. The different diagnostic tools based on ultrasonography investigated these past years to define a flow reversal in incontinent spermatic veins are presented in the first part of this review, with emphasis on subclinical varicocele. In the second part, we present our experience, together with a review of the literature concerning embolization of the spermatic veins as an alternative to surgery to treat varicoceles.