Ultrasound Evaluation of Testicular Vein Diameter in Suspected Cases of Varicocele: Comparison of Measurements in Supine and Upright Positions

Abstract

Background: Scrotal ultrasonography has high sensitivity in the detection of intra‑scrotal abnormalities. Various ultrasonographic parameters such  as the spermatic cord diameter, venous diameter, and venous retrograde flow in either supine or upright positions with or without Valsalva  maneuver have been investigated to assess patients suspected of having varicocele.

Aims: This study aimed at comparing testicular vein diameter in supine and upright positions using ultrasonography.

Methodology: This is a prospective multicenter study conducted between September 2018 and June 2019. Eighty‑two consenting suspected cases of
varicocele, 20 years and above, referred for scrotal ultrasonography were included in this study.

Results: The study population had a mean age of 42.9 + 14.89 (SD) with a range of 20–96 years. The highest number of participants fell within the
age range of 30–39 years 23 (28%). Varicocele was demonstrated in 96.3% of the patients. More patients showed sonographic evidence of varicocele in the upright position, on the right 50 (61%) as well as left 50 (61%). Bilateral varicocele had a higher frequency in the upright position 45 (54.9%), while supine was 23 (28%). Upright position had the widest diameter in 72% of participants on the right and 82% on the left. The upright position also showed higher average vein diameter of 2.6 mm and 2.9 mm on the right and left, respectively, while it was 2.2 mm and 2.3 mm for right and left in the supine position.

Conclusion: The upright position is more predictive of varicocele in scrotal ultrasound examination for suspected cases of varicocele. We  recommend an upright position where one position is to be used.

Keywords: Scanning positions, scrotal ultrasound, testicular vein, varicocele