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Updated: Jun 27, 2025
Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach
Published on: November 22, 2024
Should varicocele screening be conducted in men diagnosed with chronic venous insufficiency? A prospective study
Ferit Çetinkaya1, Kamil Doğan2, Ayşe Taş3
1Department of Cardiovascular Surgery, Ağrı Education and Research Hospital, Ağrı, Turkiye.
Insights
Chronic venous insufficiency (CVI) patients with a left great saphenous vein diameter of 5.35 cm or more may benefit from varicocele screening. This screening can help reduce male infertility rates associated with varicocele.
Area of Science:
- Vascular Surgery
- Urology
- Radiology
Background:
- Chronic venous insufficiency (CVI) shares potential pathogenesis with male varicocele.
- Varicocele is a leading cause of male infertility, affecting 40% of cases.
Purpose of the Study:
- To investigate the necessity and criteria for varicocele screening in patients diagnosed with CVI.
- To identify specific patient subgroups within CVI that warrant varicocele screening.
Main Methods:
- Prospective data collection from 102 adult male CVI patients.
- Utilized medical history, Doppler ultrasound, Mann-Whitney U test, Chi-squared test, and ROC analysis.
- Set type 1 error level at α = 0.05.
Main Results:
- A significant association was found between left great saphenous vein (GSV) diameter and varicocele (p=0.004).
- Mean left GSV diameter was significantly larger in patients with varicocele (6.6 ±2.3 cm) compared to those without (5.3 ±2.6 cm).
- Left GSV diameter of 5.35 cm or greater demonstrated 71.4% sensitivity and 61.2% specificity for varicocele detection.
Conclusions:
- A left GSV diameter of 5.35 cm or more is a reliable indicator for varicocele screening in CVI patients.
- Cardiovascular surgeons and radiologists can implement this screening protocol.
- Early detection through this method may reduce the incidence of varicocele and subsequent infertility.
Introduction:
It has been previously proposed in numerous studies that chronic venous insufficiency (CVI) has similar pathogenesis to varicocele in males. Varicocele has been identified as the most common cause of infertility in men, accounting for 40% of cases.
Aim:
This study investigates whether varicocele screening should be conducted in patients with CVI and, if so, which patients should undergo such screening.
Material And Methods:
The study included 102 adult male patients with venous insufficiency complaints who presented to the cardiovascular surgery clinic between January 2023 and June 2023. Data were prospectively collected through medical history interviews and Doppler ultrasound measurements performed by a single radiologist. The relationship between non-normally distributed measurement data of the two groups was evaluated using the Mann-Whitney U test, while the association between categorical variables was assessed using the χ2 test. ROC analysis was employed for determining predictive value. A type 1 error level of α = 0.05 was adopted.
Results:
The mean left great saphenous vein (GSV) diameter of those with varicocele (6.6 ±2.3) was significantly larger compared to the mean left GSV diameter of those without varicocele (5.3 ±2.6) (p = 0.004). The area under the ROC curve for left GSV diameter was 67% (p = 0.005). When varicocele screening is performed in patients with a left GSV diameter of 5.35 cm and above, sensitivity is 71.4% and specificity is 61.2%.
Conclusions:
There is a significant association between left GSV diameter and varicocele (p = 0.004). Varicocele screening can be carried out with 71.4% sensitivity in adult male patients with a left GSV diameter of 5.35 cm and above. Both cardiovascular surgeons and radiologists can conduct varicocele screening by measuring pampiniform veins in patients with a left GSV diameter of 5.35 cm and above. This approach has the potential to reduce the incidence of varicocele and associated infertility.
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