Skip to main content

Imaging and Other Diagnostic Modalities in Varicocele Diagnosis

  • Chapter
  • First Online:
Varicocele and Male Infertility

Abstract

The diagnosis of varicocele is generally based on medical history and clinical examination. Imaging modalities have been used as an adjunct to confirm or clarify the diagnosis in situations where history and clinical examination are indeterminate. Treatment of clinically nonpalpable varicoceles, that is, those only diagnosed on imaging, has shown no benefit in improving fertility rates and is not recommended in guidelines. This has led to a limited role for imaging in the investigation of subclinical varicoceles. Technological advances in available imaging studies may potentially expand the role of imaging in the diagnosis and treatment of varicoceles. This chapter provides a review of the available imaging modalities for varicoceles.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

US:

Ultrasonography

References

  1. Clavijo RI, Carrasquillo R, Ramasamy R. Varicoceles: prevalence and pathogenesis in adult men. Fertil Steril. 2017;108(3):364–9.

    Article  PubMed  Google Scholar 

  2. Damsgaard J, Joensen UN, Carlsen E, Erenpreiss J, Blomberg Jensen M, Matulevicius V, et al. Varicocele is associated with impaired semen quality and reproductive hormone levels: a study of 7035 healthy young men from six European countries. Eur Urol. 2016;70(6):1019–29.

    Article  CAS  PubMed  Google Scholar 

  3. Sakamoto H, Saito K, Shichizyo T, Ishikawa K, Igarashi A, Yoshida H. Color Doppler ultrasonography as a routine clinical examination in male infertility. Int J Urol. 2006;13(8):1073–8.

    Article  PubMed  Google Scholar 

  4. Jarow JP, Sharlip ID, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. J Urol. 2002;167(5):2138–44.

    Article  PubMed  Google Scholar 

  5. Stengel JW, Remer EM. Sonography of the scrotum: self-assessment module. AJR Am J Roentgenol. 2008;190(6 Suppl):S42–5.

    Article  PubMed  Google Scholar 

  6. Sommers D, Winter T. Ultrasonography evaluation of scrotal masses. Radiol Clin N Am. 2014;52(6):1265–81.

    Article  PubMed  Google Scholar 

  7. Valentino M, Bertolotto M, Derchi L, Pavlica P. Children and adults varicocele: diagnostic issues and therapeutical strategies. J Ultrasound. 2014;17(3):185–93.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Matamoros A Jr, Chen WS, et al. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1997;50(6):953–6.

    Article  CAS  PubMed  Google Scholar 

  9. Practice Committee of American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2012;98(2):294–301.

    Article  Google Scholar 

  10. Sakamoto H, Saito K, Oohta M, Inoue K, Ogawa Y, Yoshida H. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology. 2007;69(1):152–7.

    Article  PubMed  Google Scholar 

  11. Practice Committee of the American Society for Reproductive Medicine, Society for Male Reproductive and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril. 2014;102(6):1556–60.

    Article  Google Scholar 

  12. Stahl P, Schlegel PN. Standardization and documentation of varicocele evaluation. Curr Opin Urol. 2011;21(6):500–5.

    Article  PubMed  Google Scholar 

  13. Lee J, Binsaleh S, Lo K, Jarvi K. Varicoceles: the diagnostic dilemma. J Androl. 2008;29(2):143–6.

    Article  PubMed  Google Scholar 

  14. Hoekstra T, Witt MA. The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. J Urol. 1995;153(1):82–4.

    Article  CAS  PubMed  Google Scholar 

  15. Rifkin MD, Foy PM, Kurtz AB, Pasto ME, Goldberg BB. The role of diagnostic ultrasonography in varicocele evaluation. J Ultrasound Med. 1983;2(6):271–5.

    Article  CAS  PubMed  Google Scholar 

  16. Hamm B, Fobbe F, Sorensen R, Felsenberg D. Varicoceles: combined sonography and thermography in diagnosis and posttherapeutic evaluation. Radiology. 1986;160(2):419–24.

    Article  CAS  PubMed  Google Scholar 

  17. Eskew LA, Watson NE, Wolfman N, Bechtold R, Scharling E, Jarow JP. Ultrasonographic diagnosis of varicoceles. Fertil Steril. 1993;60(4):693–7.

    Article  CAS  PubMed  Google Scholar 

  18. Metin A, Bulut O, Temizkan M. Relationship between the left spermatic vein diameter measured by ultrasound and palpated varicocele and Doppler ultrasound findings. Int Urol Nephrol. 1991;23(1):65–8.

    Article  CAS  PubMed  Google Scholar 

  19. Pierik FH, Vreeburg JT, Stijnen T, van Roijen JH, Dohle GR, Lameris JS, et al. Improvement of sperm count and motility after ligation of varicoceles detected with colour Doppler ultrasonography. Int J Androl. 1998;21(5):256–60.

    Article  CAS  PubMed  Google Scholar 

  20. Pilatz A, Altinkilic B, Kohler E, Marconi M, Weidner W. Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele? World J Urol. 2011;29(5):645–50.

    Article  CAS  PubMed  Google Scholar 

  21. Bakirtas H, Cakan M, Tuygun C, Soylu SO, Ersoy H. Is there any additional benefit of venous diameter and retrograde flow volume as measured by ultrasonography to the diagnosis of suspected low-grade varicoceles? Urol Int. 2009;82(4):453–8.

    Article  PubMed  Google Scholar 

  22. Cvitanic OA, Cronan JJ, Sigman M, Landau ST. Varicoceles: postoperative prevalence--a prospective study with color Doppler US. Radiology. 1993;187(3):711–4.

    Article  CAS  PubMed  Google Scholar 

  23. Meacham RB, Townsend RR, Rademacher D, Drose JA. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol. 1994;151(6):1535–8.

    Article  CAS  PubMed  Google Scholar 

  24. Kocakoc E, Kiris A, Orhan I, Bozgeyik Z, Kanbay M, Ogur E. Incidence and importance of reflux in testicular veins of healthy men evaluated with color duplex sonography. J Clin Ultrasound. 2002;30(5):282–7.

    Article  PubMed  Google Scholar 

  25. Grasso M, Lania C, Castelli M, Galli L, Franzoso F, Rigatti P. Low-grade left varicocele in patients over 30 years old:the effect of spermatic vein ligation on fertility. BJU Int. 2000;85(3):305–7.

    Article  CAS  PubMed  Google Scholar 

  26. Yamamoto M, Hibi H, Hirata Y, Miyake K, Ishigaki T. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol. 1996;155(5):1636–8.

    Article  CAS  PubMed  Google Scholar 

  27. Unal D, Yeni E, Verit A, Karatas OF. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Int J Urol. 2001;8(5):227–30.

    Article  CAS  PubMed  Google Scholar 

  28. Skoog SJ, Roberts KP, Goldstein M, Pryor JL. The adolescent varicocele: what’s new with an old problem in young patients? Pediatrics. 1997;100(1):112–21.

    Article  CAS  PubMed  Google Scholar 

  29. El-Saeity NS, Sidhu PS. “Scrotal varicocele, exclude a renal tumour”. Is this evidence based? Clin Radiol. 2006;61(7):593–9.

    Article  CAS  PubMed  Google Scholar 

  30. Karcaaltincaba M. Demonstration of normal and dilated testicular veins by multidetector computed tomography. Jpn J Radiol. 2011;29(3):161–5.

    Article  PubMed  Google Scholar 

  31. Hanna GB, Byrne D, Townell N. Right-sided varicocele as a presentation of right renal tumours. Br J Urol. 1995;75(6):798–9.

    Article  CAS  PubMed  Google Scholar 

  32. Thompson JN, Abraham TK, Jantet GH. Metastasis to pampiniform plexus from left renal adenocarcinoma presenting with acute varicocele. Urology. 1984;24(6):621–2.

    Article  CAS  PubMed  Google Scholar 

  33. Roy CR 2nd, Wilson T, Raife M, Horne D. Varicocele as the presenting sign of an abdominal mass. J Urol. 1989;141(3):597–9.

    Article  PubMed  Google Scholar 

  34. Arslan H, Etlik O, Ceylan K, Temizoz O, Harman M, Kavan M. Incidence of retro-aortic left renal vein and its relationship with varicocele. Eur Radiol. 2005;15(8):1717–20.

    Article  PubMed  Google Scholar 

  35. Spittel JA Jr, Deweerd JH, Shick RM. Acute varicocele: a vascular clue to renal tumor. Proc Staff Meet Mayo Clin. 1959;34(5):134–7.

    PubMed  Google Scholar 

  36. Koh D-M, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. Am J Roentgenol. 2007;188(6):1622–35.

    Article  Google Scholar 

  37. Kangasniemi M, Kaipia A, Joensuu R. Diffusion weighted magnetic resonance imaging of rat testes: a method for early detection of ischemia. J Urol. 2001;166(6):2542–4.

    Article  CAS  PubMed  Google Scholar 

  38. Maki D, Watanabe Y, Nagayama M, Ishimori T, Okumura A, Amoh Y, et al. Diffusion-weighted magnetic resonance imaging in the detection of testicular torsion: feasibility study. J Magn Reson Imaging. 2011;34(5):1137–42.

    Article  PubMed  Google Scholar 

  39. Karakas E, Karakas O, Cullu N, Badem OF, Boyaci FN, Gulum M, et al. Diffusion-weighted MRI of the testes in patients with varicocele: a preliminary study. Am J Roentgenol. 2017;202(2):324–8.

    Article  Google Scholar 

  40. Gulum M, Cece H, Yeni E, Savas M, Ciftici H, Karakas E, et al. Diffusion-weighted MRI of the testis in hydrocele: a pilot study. Urol Int. 2012;89(2):191–5.

    Article  PubMed  Google Scholar 

  41. Yıldırım İO, Sağlık S, Çelik H. Conventional and ZOOMit DWI for evaluation of testis in patients with ipsilateral varicocele. Am J Roentgenol. 2017;208(5):1045–50.

    Article  Google Scholar 

  42. Çekiç B, Kiliç KK, Toslak IE, Şükun A, Sağlik S, Savaş M, et al. Correlation between semen analysis parameters and diffusion-weighted magnetic resonance imaging of the testicles in patients with varicocele: a pilot study. J Comput Assist Tomogr. 2018;42(3):423–8.

    Article  PubMed  Google Scholar 

  43. Tsili AC, Argyropoulou MI, Astrakas LG, Ntoulia EA, Giannakis D, Sofikitis N, et al. Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. Am J Roentgenol. 2013;200(3):578–85.

    Article  Google Scholar 

  44. Tsili AC, Xiropotamou ON, Sylakos A, Maliakas V, Sofikitis N, Argyropoulou MI. Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele. World J Radiol. 2017;9(2):34–45.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Raheem OA. Surgical management of adolescent varicocele: systematic review of the world literature. Urol Ann. 2013;5(3):133–9.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Varma MK, Ho VB, Haggerty M, Bates DG, Moore DC. MR venography as a diagnostic tool in the assessment of recurrent varicocele in an adolescent. Pediatr Radiol. 1998;28(8):636–7.

    Article  CAS  PubMed  Google Scholar 

  47. Ahlberg NE, Bartley O, Chidekel N, Fritjofsson A. Phlebography in varicocele scroti. Acta Radiol Diagn (Stockh). 1966;5:517–28.

    Article  Google Scholar 

  48. Lima SS, Castro MP, Costa OF. A new method for the treatment of varicocele. Andrologia. 1978;10(2):103–6.

    Article  CAS  PubMed  Google Scholar 

  49. Comhaire F, Kunnen M. Selective retrograde venography of the internal spermatic vein: a conclusive approach to the diagnosis of varicocele. Andrologia. 1976;8(1):11–24.

    Article  CAS  PubMed  Google Scholar 

  50. Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 2016;18(2):234–8.

    Article  PubMed  Google Scholar 

  51. Talaie R, Young SJ, Shrestha P, Flanagan SM, Rosenberg MS, Golzarian J. Image-guided treatment of varicoceles: a brief literature review and technical note. Semin Interv Radiol. 2016;33(3):240–3.

    Article  Google Scholar 

  52. Morag B, Rubinstein ZJ, Madgar I, Lunnenfeld B. The role of spermatic venography after surgical high ligation of the left spermatic veins: diagnosis and percutaneous occlusion. Urol Radiol. 1985;7(1):32–4.

    Article  CAS  PubMed  Google Scholar 

  53. Kaufman SL, Kadir S, Barth KH, Smyth JW, Walsh PC, White RI. Mechanisms of recurrent varicocele after balloon occlusion or surgical ligation of the internal spermatic vein. Radiology. 1983;147(2):435–40.

    Article  CAS  PubMed  Google Scholar 

  54. Murray RR, Mitchell SE, Kadir S, Kaufman SL, Chang R, Kinnison ML, et al. Comparison of recurrent varicocele anatomy following surgery and percutaneous balloon occlusion. J Urol. 1986;135(2):286–9.

    Article  PubMed  Google Scholar 

  55. Sze DY, Kao JS, Frisoli JK, McCallum SW, Kennedy WA, Razavi MK. Persistent and recurrent postsurgical varicoceles venographic anatomy and treatment with N-butyl cyanoacrylate embolization. J Vasc Interv Radiol. 2008;19(4):539–45.

    Article  PubMed  Google Scholar 

  56. Marmar JL. The evolution and refinements of varicocele surgery. Asian J Androl. 2016;18(2):171–8.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Tessler AN, Krahn HP. Varicocele and testicular temperature. Fertil Steril. 1966;17(2):201–2013.

    Article  CAS  PubMed  Google Scholar 

  58. Kormano M, Kahanpaa K, Svinhufvud U, Tahti E. Thermography of varicocele. Fertil Steril. 1970;21(7):558–64.

    Article  CAS  PubMed  Google Scholar 

  59. Vanlangenhove P, Dhondt E, Everaert K, Defreyne L. Pathophysiology, diagnosis and treatment of varicoceles: a review. Minerva Urol Nefrol. 2014;66(4):257082.

    Google Scholar 

  60. Comparison among different methods for the diagnosis of varicocele. World Health Organization. Fertil Steril. 1985;43(4):575–82.

    Google Scholar 

  61. Chen DP, Shao WM, Xu P, Qin YD. [Radionuclide scrotal imaging: an effective method for detecting varicocele]. Zhonghua nan ke xue = Natl J Androl. 2008;14(7):614–7.

    Google Scholar 

  62. Geatti O, Gasparini D, Shapiro B. A comparison of scintigraphy, thermography, ultrasound and Phiebography in grading of clinical varicocele. J Nucl Med. 1991;32(11):2092–7.

    CAS  PubMed  Google Scholar 

  63. Sheehan MM, Ramasamy R, Lamb DJ. Molecular mechanisms involved in varicocele-associated infertility. J Assist Reprod Genet. 2014;31(5):521–6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Chiba K, Ramasamy R, Lamb DJ, Lipshultz LI. The varicocele: diagnostic dilemmas, therapeutic challenges and future perspectives. Asian J Androl. 2016;18(2):276–81.

    Article  PubMed  Google Scholar 

  65. Lima SB, Cenedeze MA, Bertolla RP, Filho PA, Oehninger S, Cedenho AP. Expression of the HSPA2 gene in ejaculated spermatozoa from adolescents with and without varicocele. Fertil Steril. 2006;86(6):1659–63.

    Article  CAS  PubMed  Google Scholar 

  66. Ferlin A, Speltra E, Patassini C, Pati MA, Garolla A, Caretta N, et al. Heat shock protein and heat shock factor expression in sperm: relation to oligozoospermia and varicocele. J Urol. 2010;183(3):1248–52.

    Article  CAS  PubMed  Google Scholar 

  67. Yesilli C, Mungan G, Seckiner I, Akduman B, Acikgoz S, Altan K, et al. Effect of varicocelectomy on sperm creatine kinase, HspA2 chaperone protein (creatine kinase-M type), LDH, LDH-X, and lipid peroxidation product levels in infertile men with varicocele. Urology. 2005;66(3):610–5.

    Article  PubMed  Google Scholar 

  68. Cervellione RM, Cervato G, Zampieri N, Corroppolo M, Camoglio F, Cestaro B, et al. Effect of varicocelectomy on the plasma oxidative stress parameters. J Pediatr Surg. 2006;41(2):403–6.

    Article  PubMed  Google Scholar 

  69. Sharlip I, Jarow J, Belkar A, Damewood M, Howards S, Lipshultz L, et al. Male infertility best practice policy committee members and consultants: auanet.org; 2001 [updated 2011].

  70. Jungwirth A, Diemer T, Gohle GR, Kopa Z, Krausz C, Tournaye H. EAU guidelines on male infertility: uroweb.org; European Association of Urology 2016.

  71. Gold RH, Ehrlich RM, Samuels B, et al. Scrotal thermography. Radiology. 1977;122:129–32.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Muhannad M. Alsyouf .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Alsyouf, M.M., Stokes, P.K., Ko, E.Y. (2019). Imaging and Other Diagnostic Modalities in Varicocele Diagnosis. In: Esteves, S., Cho, CL., Majzoub, A., Agarwal, A. (eds) Varicocele and Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-79102-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-79102-9_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-79101-2

  • Online ISBN: 978-3-319-79102-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics