Varicocele grading on color Doppler

Varicocele grading on color Doppler can be done variably. The most elaborate and widely-accepted grading was given by Sarteschi, as below.

For a general discussion of this condition refer to the article: varicocele.

Evaluation

  • baseline greyscale study in supine position and measure the diameters of veins, as well as the total diameter of the plexus
  • next, do color Doppler interrogation and see reflux during Valsalva maneuver
  • repeat in standing position
  • Grading of varicocele

    • grade I
      • no dilated intrascrotal veins
      • reflux in spermatic cord veins of the inguinal region during Valsalva maneuver
    • grade II
      • prominent veins at upper pole of testis
      • reflux at upper pole veins during Valsalva maneuver
    • grade III
      • no major dilatation in supine position
      • dilated veins up to lower pole of testis seen only in standing position
      • reflux at lower pole veins during Valsalva maneuver
    • grade IV
      • dilated veins even in supine position
      • reflux during Valsalva maneuver
    • grade V
      • dilated veins
      • reflux without Valsalva maneuver

    Classification according to Sarteschi

    • grade I: reflux at the level of groin only during the Valsalva maneuver, without scrotal deformation or testicular hypotrophy

    • grade II: reflux at the level of the proximal segment of the pampiniform plexus only during the Valsalva maneuver, without scrotal deformation or testicular hypotrophy

    • grade III: reflux in the distal vessels at the level of lower scrotum only during the Valsalva maneuver, without scrotal deformation or testicular hypotrophy

    • grade IV: spontaneous reverse flow, increasing during the Valsalva maneuver, with scrotal deformation and possible testicular hypotrophy

    • grade V: resting reflux in the dilated pampiniform plexus, possibly increasing during the Valsalva maneuver, always accompanied by testicular hypotrophy