Varicocele: Ultrasound Grading of Reflux and Evaluation of Pampiniform Plexus Veins
Ultrasound Grading of Varicocele by Sarteschi Method
According to the source (Diagnostic Ultrasound Vascular, 2nd Edition, 2025), the sonographic grading of varicocele by the Sarteschi method is based on three key parameters: the presence of vein dilation, the patient's position (standing/lying), and the nature of reflux during the Valsalva maneuver. Each ultrasound degree (I–V) is matched with clinical grading.
| Ultrasound Degree | Ultrasound Findings | Clinical Grading | Clinical Findings |
|---|---|---|---|
| I | No dilation; reflux during Valsalva in the groin | Subclinical (0) | Not palpable |
| II | No dilation; reflux during Valsalva in the upper part of the testis | Subclinical (0) | Not palpable |
| III | Dilated veins only in the standing position; reflux during Valsalva in the lower part of the testis | Small (I) | Palpable only during Valsalva |
| IV | Dilated veins in the lying position; reflux may be spontaneous and increases during Valsalva | Medium (II) | Palpable in the standing position |
| V | Dilated veins in the lying position; spontaneous severe reflux does not change during Valsalva | Large (III) | Visible through the scrotal skin and palpable |
Thresholds for the Diameter of Pampiniform Plexus Veins
Specific numerical thresholds for the diameter of pampiniform plexus veins (in mm) are not specified in the presented fragments [to be clarified]. Methodological and recommended foundations for varicocele assessment are outlined in the ESUR-SPIWG guidelines (Bertolotto M et al., J Ultrasound. 2020;23(4):487-507).
Reflux Provocation
The key provocative maneuver in assessing varicocele is the Valsalva maneuver. According to the Sarteschi grading, differentiation is important: reflux occurring only during Valsalva, spontaneous reflux that increases during Valsalva, and constant spontaneous reflux that does not change during Valsalva (degree V). The patient's position (standing/lying) determines the presence of visible vein dilation.
Frequently asked questions
Which method of ultrasound grading of varicocele is described in the source?
The Sarteschi method — sonographic grading with 5 degrees (I–V), matched with clinical grading (Diagnostic Ultrasound Vascular, 2nd Edition, 2025).
How to distinguish between degree IV and V on ultrasound?
In degree IV, reflux may be spontaneous and increases during Valsalva; in degree V, spontaneous severe reflux does not change during the Valsalva maneuver.
What maneuver is used to provoke reflux?
The Valsalva maneuver. The localization of reflux (groin, upper/lower part of the testis) and body position determine the degree by Sarteschi.
Are the thresholds for vein diameter in mm specified in the source?
No, specific numerical thresholds for the diameter of pampiniform plexus veins are absent in the presented fragments [to be clarified].
What does subclinical varicocele mean?
Ultrasound degrees I and II: reflux during Valsalva without vein dilation; clinically, varicocele is not palpable (subclinical grading 0).