[Diagnosis of varicocele by Doppler effect]

Varicoceles, which may produce oligo-astherospermia are a curable cause of subfertility in the male. Doppler velocimetry of the anterior spermatic venous plexus or pampiniform plexus allows the diagnosis of clinical and infraclinical varicoceles to be confirmed. It can also assess and quantify the spontaneous increase in flow due to venous distension and Valsalva reflux related to valvular incompetence. 50 patients investigated for conjugal infertility and suffering of oligo-astherospermia were included in this study. All underwent clinical examination by an andrologist, spermatic venography and Doppler examination before and after embolization. Doppler examination was performed with patients in the dorsal decubitus position using an 8 MHz transducer. Varicocele was confirmed in 84% of patients suffering of oligo-astherospermia. --Comparison with the results on clinical examination demonstrated a specificity of 100% but a sensitivity of only 66%. --Compared with venography taken as a reference, Doppler had a sensitivity and specificity of 94% and 100% for the examinations carried out after embolization. In the hands of a suitably trained doctor, Doppler examination is today the most rapid, simplest, least costly and most reliable non invasive method for diagnosis of varicoceles. In recent months Doppler hemodynamic data have been complemented by ultrasonographic images obtained using a high resolution apparatus emitting at 7.5 MHz. In the presence of varicocele, the pampiniform plexus has an alveolar appearance and the diameter of the principal draining vein is greater than 3 mm. These dates should be compared with those obtained on venography.