[Bilateral varicocele: diagnostic implications].

If a varicocele is appreciated on the clinical examination, its presence may then be confirmed by Doppler examination. A pencil-probe Doppler stethoscope is utilized with ultrasonic conduction gel. The patient is examined in the upright position, and conducting medium is applied to the upper aspect of the scrotum. It is important that there is complete acoustic silence prior to having the patient perform the Valsalva maneuver. However, if a clinical varicocele is found on either the left or right side, the opposite side is evaluated for the presence of a "subclinical" varicocele by Doppler examination. When a "subclinical" varicocele is associated with a controlateral clinical varicocele, it is treated at the same time as the coexistent clinical varicocele. Venography is employed for the diagnosis of varicoceles only for patients in whom physical examination and Doppler studies are equivocal but highly suggestive of the presence of a varicocele. In that situation, rather than subjecting the patient to an unnecessary surgical procedure, venography may be employed to confirm the varicocele. Nowadays another diagnostic procedure is successfully used, that consists in a color ultrasound of the scrotum associated with Doppler velocimetry of the spermatic cord.