Wang X.K. 1 , Wang W.L. 2 , Wang H.Z. 1 , Che L. 3 , Fu D.J. 1 , Lai M.K. 1 , Liu Y.P. 4 1 Xiamen Chang Gung Hospital, Dept. of Urology, Xiamen, China, 2 Xiamen Chang Gung Hospital, Dept. of Ultrasonography, Xiamen, China, 3 Beijing Chao Yang Hospital, Dept. of Urology, Beijing, China, 4 Xiamen Chang Gung Hospital, Dept. of Endocrinology, Xiamen, China INTRODUCTION & OBJECTIVES: Clinical evaluations of varicocele are limited by the absence of standardized and reproducible criteria. According to the number of the internal spermatic veins ligated at microsurgical inguinal varicocelectomy, we firstly explore the prognostic relevance and relationship between varicocele grade and maximum diameter of internal spermatic vein measured with ultrasound. MATERIAL & METHODS: A total of 55 consecutive patients evaluated with either left varicocele or bilateral varicoceles underwent microsurgical inguinal varicocelectomy from April 2011 to October 2012. Varicocele grade estimation and color Doppler ultrasound measurement were both carried in a standing position with room temperature between 21.5 to 23.5 . Maximum diameters at rest and with the Valsalva maneuver were recorded. The size and number (small, less than 2.0 mm; medium, 2.0 mm or greater to less than 4.0 mm; large, 4.0 mm or greater) of the internal spermatic veins ligated were noted. Parametric analyses of the One-way ANOVA test, the correlation test and the receiver-operator characteristic (ROC) were used. RESULTS: First, the data (Table) showed that statistical difference in the numbers of large veins between grade 3 and grade 1 was significant (P= 0.001), as well as the large veins between grade 3 and grade 2 (P= 0.001). Second, the differences of maximum venous diameters measured in rest and during Valsalva with ultrasound among the grades were all statistically significant accordingly (P<0.05). However, only the presence of a grade 3 varicocele was predicted by ROC analysis which showed that venous diameters above 2.45 mm in rest (sensitivity 56.7%, specificity 84.5%) or 3.15mm during Valsalva maneuver (sensitivity 70.0%, specificity 86.2%). Third, the correlation between maximum diameters at rest and ligated veins was significant (P=0.027). CONCLUSIONS: Only grade 3 can be predicted with accuracy based on the diameter of maximum internal spermatic vein measured with ultrasound using cut-point values of >2.45 mm in rest or >3.15mm during Valsalva maneuver in the standing position. Furthermore, at least one large vein may be discovered at inguinal level in the grade 3 patients. Ultrasonographic measurement during Valsalva maneuver has limited forecast relevance. It is still a little confusing to follow clinical grading while we perform scanning. 840 Standardization of varicocele: Is it possible? Eur Urol Suppl 2013;12;e840 Grade Mean No. of Veins Maximum Diameter (mm) Sum Large Medium Small Rest Valsalva maneuver 1 6.0 ± 2.7 0.3 ± 0.5 1.8 ± 1.0 3.9 ± 2.6 1.6 ± 0.4 2.4 ± 0.4 2 5.2 ±1.6 0.4 ± 0.7 1.7 ± 1.2 3.1 ± 1.6 2.1 ± 0.5 2.7 ± 0.6 3 5.2 ± 2.1 1.0 ± 0.9 1.3 ± 1.2 2.9 ± 2.0 2.5 ± 0.6 3.5 ± 0.9

840 Standardization of varicocele: Is it possible?

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Page 1: 840 Standardization of varicocele: Is it possible?

Wang X.K.1, Wang W.L.2, Wang H.Z.1, Che L.3, Fu D.J.1, Lai M.K.1, Liu Y.P.4

1Xiamen Chang Gung Hospital, Dept. of Urology, Xiamen, China, 2Xiamen Chang Gung Hospital, Dept. of Ultrasonography,

Xiamen, China, 3Beijing Chao Yang Hospital, Dept. of Urology, Beijing, China, 4Xiamen Chang Gung Hospital, Dept. of

Endocrinology, Xiamen, China

INTRODUCTION & OBJECTIVES: Clinical evaluations of varicocele are limited by the absence of standardized and reproducible

criteria. According to the number of the internal spermatic veins ligated at microsurgical inguinal varicocelectomy, we firstly explore

the prognostic relevance and relationship between varicocele grade and maximum diameter of internal spermatic vein measured

with ultrasound.

MATERIAL & METHODS: A total of 55 consecutive patients evaluated with either left varicocele or bilateral varicoceles underwent

microsurgical inguinal varicocelectomy from April 2011 to October 2012. Varicocele grade estimation and color Doppler ultrasound

measurement were both carried in a standing position with room temperature between 21.5 to 23.5 . Maximum diameters at rest

and with the Valsalva maneuver were recorded. The size and number (small, less than 2.0 mm; medium, 2.0 mm or greater to less

than 4.0 mm; large, 4.0 mm or greater) of the internal spermatic veins ligated were noted. Parametric analyses of the One-way

ANOVA test, the correlation test and the receiver-operator characteristic (ROC) were used.

RESULTS: First, the data (Table) showed that statistical difference in the numbers of large veins between grade 3 and grade 1 was

significant (P= 0.001), as well as the large veins between grade 3 and grade 2 (P= 0.001). Second, the differences of maximum

venous diameters measured in rest and during Valsalva with ultrasound among the grades were all statistically significant

accordingly (P<0.05). However, only the presence of a grade 3 varicocele was predicted by ROC analysis which showed that

venous diameters above 2.45 mm in rest (sensitivity 56.7%, specificity 84.5%) or 3.15mm during Valsalva maneuver (sensitivity

70.0%, specificity 86.2%). Third, the correlation between maximum diameters at rest and ligated veins was significant (P=0.027).

CONCLUSIONS: Only grade 3 can be predicted with accuracy based on the diameter of maximum internal spermatic vein

measured with ultrasound using cut-point values of >2.45 mm in rest or >3.15mm during Valsalva maneuver in the standing

position. Furthermore, at least one large vein may be discovered at inguinal level in the grade 3 patients. Ultrasonographic

measurement during Valsalva maneuver has limited forecast relevance. It is still a little confusing to follow clinical grading while we