Ultrasound in varicocele

The article is expertly consulted by Master, Doctor Hoang Van Lan Duc - Doctor of Radiology - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International General Hospital. The doctor has more than 10 years of experience in the field of imaging, especially in diagnosing with emergency internal, surgical, abdominal, thoracic, musculoskeletal, neurological and thyroid, breast, ...

The varicocele is a system of veins that plays a role in circulating blood from the testicles, scrotum and along the inguinal canal to the general circulation. This blood circulation ensures the metabolism in the male sex organs, specifically the testicles, helping the testes to perform well the function of sex hormone production as well as sperm production in men.

Varicocele is an abnormal dilation of the spermatic vein in the venous plexus of the vine, usually caused by reflux from the left renal vein into the left seminal vein or from the varicocele. host into the right seminal vein.

Varicose veins are rare in children under 10 years of age, but are common at the onset of puberty in boys (about 15% - 20%). Most cases of varicocele occur on the left side (accounting for 78% - 93%), rarely on the right side, and sometimes bilaterally.
This pathology progresses according to the development of the body, which can lead to slow growth or development of the testicles on the side of the varicose veins, abnormal changes in semen in men.

The answer is yes.
Dilated varicocele can affect the metabolism of the testicles on the side of the varicose veins, limiting the endocrine function to produce male sex hormones. When varicocele lasts for a long time, testosterone hormone levels will decrease and cause erectile dysfunction. Besides, the patient's testicles will also shrink, produce less sperm, leading to physiological weakness, infertility - infertility ...

Clinically, doctors will base on functional symptoms and physical symptoms to make initial judgments / suspicions, then patients will be recommended to perform laboratory tests such as semen ultrasound. complete test, abdominal ultrasound, CT - Scanner... for more accurate results.

4.1 Physical symptoms of varicocele Patients will have some symptoms such as:
Discomfort, pain and tightness in the testicles. Occasionally, the patient has a burning sensation in the scrotum or vague discomfort in this area. Enlarged, tortuous varicose veins (like worms) in the scrotum may be seen or felt when standing up. Self palpation of one testicle is smaller than the opposite. Infertility/infertility, erectile dysfunction, impotence. 4.2 Physical symptoms of varicocele When standing in a standing position, in typical cases, varicose veins can be easily seen above and behind the testicles. If the Valsalva maneuver is performed (the patient will be instructed to run in place or exercise, or breathe in and out, etc.), the degree of dilatation can be increased through a comparative assessment of the difference in the dilatation of the muscles. seminal vein.

In addition to the patient's physical symptoms and physical symptoms, to accurately diagnose varicocele, patients need to perform laboratory tests, specifically ultrasound.
Ultrasound of the testicles is the first indicated test to evaluate the current status of the varicocele after clinical suspicions through symptoms. This is a simple, non-invasive method, with low cost and high specificity, which can support early diagnosis of undetectable cases in clinical practice.

5.1 Color Doppler Ultrasound The patient will have color Doppler ultrasound of the varicocele to assess the degree of dilation.
Normally, the diameter of the varicocele is less than 2mm. If the patient has varicocele, the diameter will now be larger than 2mm, with reflux causing the veins to enlarge when the patient stands up or breathes in to stretch the abdomen.
Ultrasound examination will diagnose dilated varicocele when the diameter of the vas deferens is greater than 2.5mm and is combined with the Valsalva maneuver to evaluate discreet cases. Based on Satechi's classification, there are 5 degrees of varicocele based on Doppler ultrasound, including:
Grade 1: no varicocele in the scrotum, in the varicocele in the inguinal canal, there is reflux. reflux) during the Valsava maneuver. Grade 2: no varicose veins in the supine position, in the standing position, and with localized reflux in the upper pole of the testicle when performing the Valsava maneuver. Grade 3: no varicose veins in the supine position, the standing position is dilated and there is diffuse reflux in the upper and lower poles of the testicle when performing the Valsava maneuver. Grade 4: varicocele and reflux during the Valsava maneuver in the supine position. Grade 5: dilatation and reflux even without the Valsava maneuver.

5.2 Abdominal ultrasound – computed tomography of the abdomen After Doppler ultrasound of the testicular veins, follow-up tests to diagnose varicocele include abdominal ultrasound and computed tomography Abdominal. These examinations may assist in ruling out varicocele secondary to tumor compression.
Testicular ultrasound is one of the prerequisite tests to accurately diagnose varicocele effectively. In addition, the patient will also be recommended other tests to determine the cause, thereby taking appropriate treatment.
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