Cornud et al. classified varicoceles according to the duration of reflux: described as brief (less than 1 s), intermediate (1–2 s) and permanent (> 2 s). Permanent reflux (> 2 s) was not palpable in 40% of the patients but was always evident at venography. After varicocele repair, reflux disappeared in 70% of cases and changed from continuous to intermediate type in 20%. Oyen et al. also considered a cut-off of 2 s diagnostic for the diagnosis of a varicocele.

The following information should be included in the US report:

  1. Testicular volume, echogenicity and echotexture
  2. Presence of incidental testicular or extratesticular abnormalities other than varicoceles
  3. Presence of varices at grey-scale and colour Doppler US, and relationships to the testis (inguinal canal, supra-testicular, around the testis, intratesticular)
  4. Diameter of the largest vein (irrespective of the location) measured while standing and during the Valsalva manoeuvre
  5. Changes of flow at colour Doppler interrogation and spectral analysis in the spermatic veins according to the patient’s position and before and during Valsalva (length of reflux and changes in waveform characteristics while standing and during the Valsalva manoeuvre).

It also suggests grading varicoceles according to the Sarteschi’s classification


Bertolotto M, Freeman S, Richenberg J, Belfield J, Dogra V, Huang DY, Lotti F, Markiet K, Nikolic O, Ramanathan S, Ramchandani P. Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations. Journal of Ultrasound. 2020 Jul 27:1-21.

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