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

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