• L A Eskew, N E Watson, N Wolfman, R Bechtold, E Scharling, and J P Jarow.
• Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1094.
• Fertil. Steril. 1993 Oct 1; 60 (4): 693-7.

ObjectiveTo assess the ability of color duplex scrotal ultrasonography to detect subclinical varicoceles and confirm the diagnosis of clinical varicoceles.DesignPhysical examination, color duplex scrotal ultrasonography and internal spermatic venography was performed on 64 testicular units in 33 men.SettingMale fertility center.PatientsTwo hundred sixty-two consecutive men being evaluated for male factor infertility of whom 33 agreed to undergo venography.Main Outcome MeasuresUltrasonographic measurement of scrotal vein diameter of patients in the supine and upright position, before and during valsalva maneuver, and scrotal vein blood flow reversal with valsalva maneuver was compared with the findings of varicocele by physical examination and venography.ResultsThe best predictor of a varicocele was internal spermatic vein diameter, and the best overall performance of ultrasonography was achieved with the patient at rest in the supine position. The best cutoff point for venous diameter for a clinical varicocele was 3.6 mm and 2.7 mm for a subclinical varicocele, but the overall accuracy was only 63%.ConclusionsConfirmatory studies are needed to support the ultrasonographic diagnosis of varicoceles before considering surgical repair.

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