The value of ultrasonography in the diagnosis of varicocele

• Authors: Tomasz Lorenc , Leszek Krupniewski , Piotr Palczewski , Marek Gołębiowski

Title variants

PL

Wartość ultrasonografii w diagnostyce żylaków powrózka nasiennego

• Languages of publication: EN PL

Abstracts

EN

A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. Varicocele can impair spermatogenesis and is considered to be the most common cause of male infertility. Patients may palpate a thickening in the scrotum or complain of dull scrotal or inguinal pain, which increases when standing or during erection. In the case of a sudden onset of varicocele in elderly men, it is necessary to exclude renal tumor and extend diagnostic ultrasound with the assessment of the abdominal cavity. The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Ultrasound is the imaging method of choice. The width and the number of vessels in the pampiniform plexus as well as the evaluation and measurement of regurgitation during the Valsalva maneuver are typical parameters analyzed during ultrasound assessment. However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. As a result of introduction of clear ultrasound criteria as well as the development of elastography and nuclear magnetic resonance, diagnostic imaging can play an important role in assessing the risk of damage to the testicular parenchyma, qualifying patients for surgical treatment and predicting the effects of therapy.

PL

Żylaki powrózków nasiennych to patologicznie poszerzone, kręte żyły splotu wiciowatego, prowadzące do wzrostu temperatury jąder i refluksu metabolitów z nadnerczy do jąder. Żylaki powrózków nasiennych mogą zaburzać spermatogenezę i uważane są za najczęstszą przyczynę niepłodności u mężczyzn. Chorzy mogą wyczuwać zgrubienie w mosznie lub skarżyć się na tępe pobolewanie moszny bądź pachwiny, nasilające się w pozycji stojącej lub w czasie erekcji. Nagłe pojawienie się żylaków powrózka nasiennego u starszych mężczyzn wymaga wykluczenia guza nerki i konieczne jest wówczas poszerzenie diagnostyki ultrasonograficznej o badanie jamy brzusznej. Podstawą rozpoznania żylaków powrózka nasiennego są wywiad i badanie przedmiotowe, które opiera się na palpacji i obserwacji worka mosznowego w spoczynku oraz podczas próby Valsalvy. Ultrasonografia stanowi metodę z wyboru w ocenie obrazowej. Szerokość i liczba nakoczyń splotów wiciowatych oraz ocena i pomiar fali wstecznej podczas próby Valsalvy to typowe parametry brane pod uwagę podczas oceny ultrasonograficznej. Diagnostyka ultrasonograficzna jest jednak nadal metodą kontrowersyjną, ze względu na liczne, często rozbieżne klasyfikacje służące ocenie żylaków, jak również niską korelację z objawami klinicznymi. Opracowanie jasnych kryteriów ultrasonograficznych oraz rozwój elastografii i tomografii rezonansu magnetycznego mogą sprawić, że w przyszłości diagnostyka obrazowa będzie odgrywać istotną rolę w ocenie ryzyka uszkodzenia miąższu jąder, kwalifikowaniu pacjentów do leczenia operacyjnego i przewidywaniu efektów terapii.

Keywords

EN

infertility; moszna; niepłodność; powrózek nasienny; scrotum; spermatic cord; ultrasonografia; ultrasonography; varicocele; żylaki powrózkanasiennego

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Journal of Ultrasonography
• Year: 2016
• Volume: 16
• Issue: 67
• Pages: 359–370

Contributors

author

Tomasz Lorenc

• 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland

author

Leszek Krupniewski

• 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland

author

Piotr Palczewski

• 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland

author

Marek Gołębiowski

• 1st Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland

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• Document Type: article