title: Redefining the Criteria for Grading Varicoceles Based on Reflux Times: A Clinicoradiological Correlation.
abstract: The aims of the study were to redefine the criteria used to grade varicoceles, based on reflux times that correlate with Dubin and Amelar clinical grading by overcoming the limitations of clinical grading and to include the less known entity of intratesticular varicoceles in the grading. Prospective correlative study was undertaken at JSS Hospital, Mysore, India during the period from July 2010 to October 2014. All patients with clinical suspicion of varicocele were clinically graded by Dubin and Amelar grading system and were later subjected to duplex ultrasound examination. The duration of the reflux obtained during the Valsalva maneuver was measured in milliseconds. Patients with intratesticular varicocele were noted and they were subgraded. One hundred patients were examined as per the methodology.The mean reflux times obtained as per the clinically graded varicoceles were as follows: subclinical varicocele, 835 ms; grade 1 varicocele, 1907 ms; grade 2 varicocele, 3108 ms; and grade 3 varicocele, 4508 ms.Based on the results obtained, we propose a modified radiological grading of the varicocele that is based on reflux times at Valsalva maneuver for each clinical grade. The presence of an intratesticular varicocele with any of the above grades is to be suffixed with "I."
authors.affiliation: Department of Radiodiagnosis, JSS Medical College and Hospital, JSS University, Mysore, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patil
authors.forename: S M Chandrashekar
authors.initials: SM
authors.lastname: Shetty
authors.forename: Sudha Kiran
authors.initials: SK
authors.lastname: Das
mesh_terms: D000328:Adult; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007194:India; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods* / Q000592:standards*; D014646:Varicocele / Q000000981:diagnostic imaging*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging*; D055815:Young Adult