Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis

Abstract

Purpose: To determine effectiveness of Valsalva maneuver and standing position on scrotal color Doppler ultrasound (CDU) for the varicocele diagnosis.

Materials and methods: We reviewed the physical examination and CDU finding in 87 patients who visited National Police Hospital from January 2011 to April 2014. Diameters of pampiniform plexus were measured bilaterally during resting and Valsalva maneuver in the supine position and standing position. We calculated the ratio of mean of maximal vein diameter (mMVD) during resting and Valsalva maneuver (resting-Valsalva ratio) and compared in the both position.

Results: In the resting and supine position, mMVD of varicocele testis units were 1.8 mm, 2.1 mm, 2.6 mm (grades I, II, III, respectively), and that of normal testis units (NTU) 1.2 mm. During Valsalva maneuver in the supine position, mMVD were 3.0 mm, 3.4 mm, 4.2 mm (grades I, II, III) vs 1.8 mm (NTU) (p=0.007, p<0.001, p<0.001, respectively). Average of resting-Valsalva ratio in the supine position were 0.69, 0.74, 0.74 (grades I, II, III) and 0.67 (NTU). Whereas in the resting and standing position, mMVD were 2.8 mm, 3.3 mm, 3.8 mm (grades I, II, III) and 1.8 mm (NTU) (p=0.002, p<0.001, p<0.001). During Valsalva maneuver in the standing position, mMVD were 5.0 mm, 5.8 mm, 6.6 mm (grades I, II, III) and 2.5 mm (NTU) (p=0.002, p<0.001, p<0.001). And average resting-Valsalva ratio were 0.76, 0.90, 0.71 (grades I, II, III) and 0.26 (NTU), which showed significant differences from all grades (p<0.001, p<0.001, p<0.001).

Conclusions: It is suggested that the standing position and Valsalva maneuver during CDU could improve diagnostic ability for varicocele. Resting-Valsalva ratio in the standing position could be a new diagnostic index for varicocele diagnosis using CDU.

Keywords: Doppler ultrasonography; Valsalva maneuver; Varicocele.

Fig. 1

Color Doppler ultrasonography of varicocele. Maximal venous diameters in the pampiniform plexus were measured during resting (A) and during a Valsalva maneuver (B) in the standing position.

Fig. 2

(A) Mean maximal vein diameter (mMVD) of varicocele testis units upon scrotal color Doppler ultrasonography in the supine position at rest. (B) mMVD of varicocele testis units upon scrotal color Doppler ultrasonography in the supine positing during a Valsalva maneuver. (C) Average resting-Valsalva ratio [=(mMVD during Valsalva-mMVD during resting)/mMVD during resting] in the supine position. Gr, grade. ^*mMVD of no varicocele units (mm)=1.8±0.9.

Fig. 3

(A) Mean maximal vein diameter (mMVD) of varicocele testis units upon scrotal color Doppler ultrasonography in the standing position at rest. (B) mMVD of varicocele testis units upon scrotal color Doppler ultrasonography in the standing position during a Valsalva maneuver. (C) Average resting-Valsalva ratio in the standing position. Gr, grade. ^*mMVD of no varicocele units (mm)=1.8±1.2. ^**mMVD of no varicocele units (mm)=2.5±0.3.