title: Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis.
abstract: OBJECTIVE
  To determine effectiveness of Valsalva maneuver and standing position on scrotal color Doppler ultrasound (CDU) for the varicocele diagnosis.
  
  
  METHODS
  We reviewed the physical examination and CDU finding in 87 patients who visited National Police Hospital from January 2011 to April 2014. Diameters of pampiniform plexus were measured bilaterally during resting and Valsalva maneuver in the supine position and standing position. We calculated the ratio of mean of maximal vein diameter (mMVD) during resting and Valsalva maneuver (resting-Valsalva ratio) and compared in the both position.
  
  
  RESULTS
  In the resting and supine position, mMVD of varicocele testis units were 1.8 mm, 2.1 mm, 2.6 mm (grades I, II, III, respectively), and that of normal testis units (NTU) 1.2 mm. During Valsalva maneuver in the supine position, mMVD were 3.0 mm, 3.4 mm, 4.2 mm (grades I, II, III) vs 1.8 mm (NTU) (p=0.007, p<0.001, p<0.001, respectively). Average of resting-Valsalva ratio in the supine position were 0.69, 0.74, 0.74 (grades I, II, III) and 0.67 (NTU). Whereas in the resting and standing position, mMVD were 2.8 mm, 3.3 mm, 3.8 mm (grades I, II, III) and 1.8 mm (NTU) (p=0.002, p<0.001, p<0.001). During Valsalva maneuver in the standing position, mMVD were 5.0 mm, 5.8 mm, 6.6 mm (grades I, II, III) and 2.5 mm (NTU) (p=0.002, p<0.001, p<0.001). And average resting-Valsalva ratio were 0.76, 0.90, 0.71 (grades I, II, III) and 0.26 (NTU), which showed significant differences from all grades (p<0.001, p<0.001, p<0.001).
  
  
  CONCLUSIONS
  It is suggested that the standing position and Valsalva maneuver during CDU could improve diagnostic ability for varicocele. Resting-Valsalva ratio in the standing position could be a new diagnostic index for varicocele diagnosis using CDU.
authors: Department of Urology, National Police Hospital, Seoul, Korea.
authors: Yoo Seok
authors: YS
authors: Kim
authors: Department of Urology, National Police Hospital, Seoul, Korea.
authors: Soon Ki
authors: SK
authors: Kim
authors: Department of Urology, National Police Hospital, Seoul, Korea.
authors: In-Chang
authors: IC
authors: Cho
authors: Department of Urology, National Police Hospital, Seoul, Korea.
authors: Seung Ki
authors: SK
authors: Min
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D011187:Posture / Q000502:physiology; D012611:Scrotum / Q000000981:diagnostic imaging*; D016683:Supine Position / Q000502:physiology; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D014636:Valsalva Maneuver; D014646:Varicocele / Q000000981:diagnostic imaging*; D014680:Veins / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Doppler ultrasonography; Valsalva maneuver; Varicocele