Clinical grading and color Doppler ultrasonography-based grading of varicocele: how compatible are the two grading systems?

objectiveInhere, we compared two of the most common grading systems based on color Doppler ultrasonography (CDU) and physical examination in patients suspected of varicocele.

methodsThis is a cross-sectional study. Overall, 66 patients clinically suspected of varicocele were visited by an attending urologist and a radiologist for physical examination and CDU. Varicocele was then graded according to the WHO criteria and Sarteschi criteria. For comparing the results of the two grading systems, each grading systems was then categorized into four scoring groups. Clinical- and CDU-based scoring, and mean maximum variceal vein diameter (MMVD) were evaluated and compared.

resultsThe two scoring systems were statistically similar (p < 0.001). CDU scoring of right and left testicles had significant agreement with clinical scoring of varicocele (κ = 0.723 and κ = 0.809, respectively; p < 0.001). MMDV was associated with clinical (right sided: r = 0.681; left sided: r = 0.797; p < 0.001) and ultrasonography scoring (right sided: r = 0.648; left sided: r = 0.821; p < 0.001).

conclusionGrades zero, one and two in ultrasonographic grading are most compatible with grade zero (sub-clinical) in clinical evaluation; so these grades most probably remain undetected in routine physical examination. Furthermore, grade three in ultrasonography and grade one in clinical grading, grade four in ultrasonography and grade two in clinical grading, and finally grade five in ultrasonography and grade three in clinical grading are most compatible. So, by deducting two grades from the ultrasonography grading of varicocele measured by the Sarteschi method, one can obtain a compatible estimate of the clinical grading.