[Diagnosis of varicocele with bidirectional Doppler sonography. A contribution to the pathogenesis of varicocele].

A total of 375 patients with varicocele were examined by bidirectional Doppler sonography. Venous reflux was classified as one of two Doppler grades: spontaneous reflux and Valsalva-induced reflux. The Doppler grades were compared with clinical aspects (e.g. size) of the varicocele. Using bidirectional recording, it is possible to describe two hemodynamically different types of varicoceles (the pressure type and the shunt type). On the basis of the Doppler results the pathogenesis of varicocele can be determined. Spontaneous reflux causes the shunt type and the medium-sized and large varicocele, while Valsalva-induced reflux causes the pressure type or the stop type and the small and subclinical varicocele.