Standardization and documentation of varicocele evaluation

Our present understanding of the clinical impact of varicocele on male fertility and the efficacy of varicocele treatment is limited by the absence of an objective, reproducible, and standardized diagnostic evaluation. Herein we review the clinical evaluation of varicocele. The prognostic relevance of varicocele grade and venous diameter measured with ultrasound is explored.

A directed history, physical examination of the warmed scrotum, and results of one or multiple semen analyses must be documented in all men with varicoceles. Color Doppler ultrasonography is indicated in cases when the physical examination is indeterminate. Unfortunately, physical examination is limited by intraobserver and interobserver bias, and standardized criteria for the ultrasonographic diagnosis of varicocele do not exist. Despite these limitations, both varicocele grade and venous diameter measured on ultrasound are prognostically useful parameters. In select cases, measurement of serum testosterone and assessment of sperm DNA integrity may also be clinically helpful.

The absence of standardized, reproducible clinical, and radiographic evaluations for varicocele has contributed substantially to our present difficulties in selecting patients who are likely to benefit from varicocele treatment and in counseling affected men. Consensus regarding the optimal evaluation of varicoceles and widespread acceptance of a standardized evaluation is necessary.