Comparative evaluation of visual-palpatory findings with scrotal doppler ultrasound data for varicocele diagnosis

Introduction. Current evidence suggests that management of any grade of varicocele can improve male fertility. However, diagnosis of grade 1 varicocele in infertile men without the use of scrotal Doppler ultrasound may cause overtreatment.

Objective. To study the comparability and accuracy of the visual palpatory examination method with the scrotal Doppler ultrasound data for the diagnosis of varicocele.

Material & methods. Between November 2005 to January 2022, 2871 patients diagnosed with varicocele and infertility who underwent microsurgical varicocelectomy by inguinal access were examined at RSSPMCU. The average age of the patients was 30.16 ± 0.09 (18 – 60) years. Of the 2871 patients, 2592 (90.3%) were diagnosed by physical examination, and 279 (9.7%) patients underwent additional scrotal Dopper ultrasound.

Results. After Doppler scrotal imaging was introduced into practice, the proportion of patients with bilateral varicocele increased from 32.2% to 61.6% (p < 0.01). The proportion of patients with right-sided varicocele also increased significantly. Experienced physicians during physical examination of infertility patients did not diagnose grade 1 varicocele in 4.3%.

Conclusions. The implementation of scrotal Doppler ultrasound for the diagnosis of male infertility improved the detection of grade 1 varicocele and bilateral varicocele. In turn, this contributed to earlier elimination of the male factor of infertility in this contingent of patients.

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