Caşkurlu Turhan, Taşçi Ali Ihsan, Resim Sefa, Sahinkanat Tayfun, Ekerbiçer Hasan
Department of Urology, Sisli Etfal Hospital, Istanbul, Turkey.
Urol Int. 2003;71(1):83-6. doi: 10.1159/000071100.
The diameters of the veins in the pampiniform plexus have been used to diagnose subclinical varicocele. But there are many cutoff points and some controversies about the diagnosis. These cause difficulty in the evaluation of the results of epidemiological and clinical studies. Our aim is to establish the reliability of vein diameters in the pampiniform plexus in the diagnosis of subclinical varicocele.
Physical examination, scrotal gray scale ultrasonography (SU) and color Doppler ultrasonography (CDU) were performed to assess varicocele in 100 infertile patients without clinical varicocele (group I), 100 infertile patients with clinical left varicocele (group II), and 50 fertile men without clinical varicocele (group III) as a control group. The diameter of the veins in the pampiniform plexus was measured with SU. According to various cutoff points of venous diameter and CDU criteria, the diagnosis of varicocele was made. The highest mean venous diameters were calculated with and without varicocele in men whose diagnoses had been made with CDU. The results were correlated with each other and the control group.
According to venous diameter cutoff points, the varicocele ratio did not correlate with the CDU results (p < 0.05) except for the left side of patients with clinical left-sided varicocele. The highest mean diameters of the veins in group III (control group) did not show a significant difference to the other groups (p > 0.05) except for the left side of group II patients. We did not find an exact relation between the highest venous diameter in the men who have and those who do not have subclinical varicocele with CDU. The highest mean diameter was 2.17 +/- 0.34 (SD) mm for men who have subclinical varicocele and 2.00 +/- 0.31 mm for men who do not have subclinical varicocele by CDU (p < 0.05).
Our results indicate that venous diameters should not be used as diagnostic criteria for subclinical varicocele. Only the evaluation of venous diameter in varicocele should be used to document and quantify pathology, but it should not be used to establish the diagnosis.
精索静脉丛中静脉直径已被用于诊断亚临床型精索静脉曲张。但存在许多诊断切点且在诊断方面存在一些争议。这些给流行病学和临床研究结果的评估带来困难。我们的目的是确定精索静脉丛中静脉直径在诊断亚临床型精索静脉曲张方面的可靠性。
对100例无临床精索静脉曲张的不育患者（I组）、100例有临床左侧精索静脉曲张的不育患者（II组）以及50例无临床精索静脉曲张的有生育能力男性（III组，作为对照组）进行体格检查、阴囊灰阶超声检查（SU）和彩色多普勒超声检查（CDU）以评估精索静脉曲张。用SU测量精索静脉丛中静脉的直径。根据静脉直径的不同切点和CDU标准进行精索静脉曲张的诊断。对已通过CDU诊断的男性，计算有和无精索静脉曲张时静脉的最高平均直径。将结果相互关联并与对照组进行比较。
根据静脉直径切点，除临床左侧精索静脉曲张患者的左侧外，精索静脉曲张比例与CDU结果不相关（p < 0.05）。III组（对照组）静脉的最高平均直径与其他组相比，除II组患者左侧外，无显著差异（p > 0.05）。我们未发现通过CDU诊断的有和无亚临床型精索静脉曲张男性的最高静脉直径之间存在确切关系。通过CDU诊断，有亚临床型精索静脉曲张男性的最高平均直径为2.17±0.34（标准差）mm，无亚临床型精索静脉曲张男性的最高平均直径为2.00±0.31 mm（p < 0.05）。
我们的结果表明，静脉直径不应作为亚临床型精索静脉曲张的诊断标准。精索静脉曲张中静脉直径的评估仅应用于记录和量化病理情况，但不应将其用于确立诊断。
