Department of Urology, Pediatric Urology and Andrology, University Hospital Giessen and Marburg GmbH-Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany.
World J Urol. 2011 Oct;29(5):645-50. doi: 10.1007/s00345-011-0701-4. Epub 2011 May 24.
Investigating the diagnostic value of color Doppler ultrasound for defining the varicocele grade according to WHO criteria.
A total of 217 men (129 with clinical varicocele and 88 without clinical varicocele) were investigated by physical examination and color Doppler ultrasound and categorized according to WHO varicocele criteria (0, subclinical, I, II, and III). Diameter and reflux of the largest vein in the pampiniform plexus were measured bilaterally with the patient in the supine position in rest and during the Valsalva maneuver. To assess the possibility of differentiating varicocele grade by venous diameter, optimal cut-point values were determined by receiver-operator characteristic (ROC) analysis.
With increased varicocele grade, a larger vein diameter was more significant in rest and during Valsalva (in all cases P < 0.05), except between grade I and grade II. Retrograde peak flow velocities were similar in every group (in all cases P > 0.1). Only grade III varicoceles demonstrated significantly increased peak flow values compared with all other grades (P < 0.001). There were no side-related differences when comparing identical varicocele grades (in all cases P > 0.1). Venous diameters above 2.45 mm in rest (sensitivity 84%, specificity 81%) or 2.95 mm during Valsalva (sensitivity 84%, specificity 84%) predicted the presence of a clinical varicocele.
Our findings support the hypothesis that clinical varicoceles can be predicted with high accuracy based only on the diameter of testicular veins using cut-point values of >2.45 mm in rest or >2.95 mm during Valsalva maneuver in the supine position.
探讨彩色多谱勒超声根据世界卫生组织(WHO)标准对精索静脉曲张分级的诊断价值。
通过体格检查和彩色多谱勒超声检查对 217 名男性(129 例临床精索静脉曲张和 88 例无临床精索静脉曲张)进行研究,并根据 WHO 精索静脉曲张标准(0 级、亚临床、I 级、II 级和 III 级)进行分类。在患者仰卧位休息和valsalva 动作时,双侧测量精索蔓状静脉丛中最大静脉的直径和反流。通过接收者操作特性(ROC)分析确定静脉直径区分精索静脉曲张分级的最佳截断值。
随着精索静脉曲张程度的增加,静息和valsalva 时静脉直径越大(所有情况下 P < 0.05),除了 I 级和 II 级之间。各组反流峰值流速相似(所有情况下 P > 0.1)。只有 III 级精索静脉曲张与所有其他等级相比,峰值流速显著增加(P < 0.001)。当比较相同的精索静脉曲张等级时,没有与侧支相关的差异(所有情况下 P > 0.1)。静息时静脉直径大于 2.45mm(敏感性 84%,特异性 81%)或valsalva 时 2.95mm(敏感性 84%,特异性 84%)可预测临床精索静脉曲张的存在。
我们的研究结果支持这样一种假设,即仅根据精索静脉直径,使用静息时>2.45mm 或仰卧位valsalva 时>2.95mm 的截断值,可准确预测临床精索静脉曲张的存在。