Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach

Summary

Varicocele relies heavily on angiographic diagnostic techniques for disease-related examination and assessment. In order to diagnose varicocele better, we combined supine and standing positions for varicocele imaging, and contrast-enhanced ultrasound is used for patients with inconspicuous reflux. This approach facilitates the early detection, diagnosis, and treatment of varicocele.

Abstract

Varicocele, one of the main diseases affecting male reproductive health, relies heavily on angiographic diagnostic techniques for disease-related examination and assessment. Traditional varicocele angiography often employs a supine position to facilitate the relaxation of the groin area muscles, the insertion of the angiography catheter, and imaging. However, the supine position may cause blood reflux, thus underestimating the clinical incidence of varicocele, particularly resulting in missed diagnoses of right-sided or bilateral varicoceles. To address this issue, this study proposes the combined use of supine and standing positions for varicocele imaging. The standing position increases lower abdominal pressure, making the degree of varicosity more prominent in the images. Compared to the sole use of the supine position, the method employed in this study effectively reduces the misdiagnosis rate of right-sided or bilateral varicoceles. This approach aims to facilitate the early detection, diagnosis, and treatment of varicocele, effectively reducing the potential threat of the disease to male reproductive health. It also helps improve the accuracy of disease assessment, providing more references for selecting subsequent treatment plans.

Introduction

Globally, infertility has gradually emerged as an issue of pressing concern for clinicians and researchers, with related disorders receiving significant attention. Among these, varicocele (VC) is considered one of the primary causes of male infertility, especially with an incidence rate reaching up to 80% in the secondary infertile population¹. Accurate and timely diagnosis for such diseases is pivotal, as it directly dictates the subsequent choice of treatment and its efficacy.

The conventional diagnostic method for varicocele primarily relies on clinical manifestations and physical examinations²

Protocol

This study received approval from the Shanghai Hospital of Planned Parenthood Research. The diagnostic criteria, surgical indications, and contraindications are in line with the expert consensus of the "Guidelines for Andrological Diagnostics and Treatment," the "Chinese Andrology Society," and the "European Association of Urology Sexual and Reproductive Health Guidelines." Patients with female partners suffering from diseases affecting fertility were excluded from this study. Informed consent was.......

Discussion

With the intensification of research in the realm of male reproductive health in recent years, varicocele has been recognized as one of the primary factors affecting male fertility. Although its clinical manifestations are diverse, accurate and effective diagnosis remains a pivotal step in determining therapeutic outcomes. Physical examination (PE) is extremely important in screening for varicocele; a worm-like varicose vein at the base of the scrotum can be seen in severe varicocele patients, and for mild to moderate va.......

Materials

Name	Company	Catalog Number	Comments
Dianerkang Iodophor Skin Disinfectant	Shanghai Likang Disinfectant HI-Tech Co,Lid	31005102	For skin disinfection and the effective iodine content is from 4.5g/L~5.5g/L
Disposable dressing forceps	Jiaxing Zhongxin Medical Instrument Co., Ltd	MLD-01	Holding disinfectant cotton balls for disinfection
Physiological saline	Shanghai Kindly Medical Instruments Co., Ltd	2452161324	Used for injecting contrast agents
Shallow probe (high frequency)	General Electric Company	Voluson E6	Devices for transmitting and receiving ultrasonic waves
Sulfur hexafluoride microbubbles for injection	BRACCO INTERNATIONAL BV	SonoVue	Improve the ultrasound echo rate of blood, thereby improving the contrast between blood and surrounding tissues
Ultrasonic coupling agent	Shanghai Junkang Medical Equipment Co., Ltd	DS-1	Eliminate air gaps between the probe and the detected object, improve the transmission efficiency of ultrasound
Ultrasound diagnostic equipment	General Electric Company	Voluson E6	Process and display the signal received from the probe
Vein Detained Needle	Shanghai Kindly Medical Instruments Co., Ltd	60017202	Indwelling venous channels to reduce drug leakage and save time