Color Doppler ultrasound of varicocele

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Tran Cong Trinh - Radiologist - Radiology Department - Vinmec Central Park International General Hospital. The doctor has many years of experience in the field of diagnostic imaging.
The association of varicocele with male infertility is well documented in the literature and is a common finding in adolescents and adult men. Early and accurate diagnosis of this disease is very important because timely correction will help improve semen quality. In which, color Doppler ultrasound is the main tool for diagnosis.

1. Physiology of the male reproductive system

The male reproductive system produces, stores, and releases sperm that are active during fertilization. The scrotum acts like a sac of skin that contains the testicles, which are the organs that make sperm and the hormone testosterone. Sperm mature while traveling through the epididymis behind each testicle, enter the vas deferens, travel together in the urethra, and ejaculate out of the penis upon arousal. The epididymis is a bundle of vessels that includes the vas deferens and the testicular artery that carries blood to and a network of veins that carry blood back from the testicles. It is this network of veins that acts as a countercurrent heat exchanger, helping the testes to have a local temperature lower than the body's temperature, facilitating the production, maturation and optimal functioning of the testicles. sperm. When these veins become dilated as in varicocele, overheating of the testicles can impair sperm function and production leading to lower fertility.

2. What is varicocele?

Varicocele is when the small venous plexus in the scrotum becomes enlarged. These veins resemble the varicose veins seen in the legs, twisted, swollen veins.
Varicose veins can begin to form during puberty in about 10 to 15 boys out of every 100 boys. The diameter of the veins can grow larger and the man himself may notice them increasing rapidly over time. Varicose veins are more common on the left side of the scrotum, because the anatomical features of men on both sides are not the same. However, varicocele can still exist on both sides at the same time but these cases are very rare.
Most cases of men getting varicose veins do not cause problems, can be considered harmless. Even so, a small number of patients with varicocele can cause pain, problems with childbirth, or a slower growth or atrophy of one testicle.

3. How to diagnose varicocele?

Varicose veins are initially found by the patient herself through self-examination of the scrotum, palpation of abnormally large, distended, or routine physical examination.
A urologist or a gynecologist usually checks for varicocele while the patient is standing. You may also be asked to take deep breaths, hold your breath, and bend over while the doctor feels the scrotum above the testicle. This technique, known as the "Valsalva maneuver", aims to increase the pressure in the venous return, making the varicose veins more visible.
In addition, the urologist may also order an ultrasound test of the scrotum that uses sound waves to create an image of what's inside the body. The sign of varicocele on ultrasound is when the diameter of the veins is more than 3mm wide with retrograde bleeding during the Valsalva maneuver. In addition, an ultrasound can also show the size of the testicle, whether there are any complications from varicocele.

4. How to evaluate varicocele ultrasound?

Currently, ultrasound is the most commonly performed imaging technique in patients with varicocele. Non-invasiveness, patient safety and wide availability are the main advantages of this approach. A linear transducer with a frequency of 7–14 MHz and also with real-time Doppler functionality is the minimum requirement for performing an ultrasound evaluation of varicocele.
Also, it is important to avoid undue compression of the scrotum from compression on the ultrasound transducer as this will reduce the vessel diameter and increase the flow rate during Doppler analysis. In addition, the ultrasound examination of varicocele should also be performed in a warm room, using pre-warmed ultrasound gel as well as ensuring intimacy and privacy for the patient.
Ultrasound of varicocele was performed in the patient in the supine position. First, the doctor will examine the scrotum manually to determine the exact location to place the ultrasound probe. Measurement of the diameter of the veins in the plexus and assessment of venous reflux was performed in the supine position and then compared with the Valsalva maneuver.

In addition, ultrasound evaluation of varicocele should also be performed in the standing position and include vessel diameter measurement with assessment of changes in flow direction compared with rest and exercise. Valsalva.
The inguinal canal, the upper part of the scrotum as well as the lower abdomen, pelvic fossa and peritoneum should also be examined for possible obstruction of the varicocele.
In summary, because the diagnosis of varicocele associated with infertility is well established, an indication of ultrasonography is the imaging technique of first choice to rapidly identify this problem. Thanks to its wide availability, high reproducibility, low cost and no side effects, doctors can order multiple ultrasound scans of varicocele to monitor disease progression before deciding to intervene. .
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Article referenced source: NCBI