Vikram Patil MBBS, Presenter: Nothing to Disclose

Chandrashekhar Shety, Abstract Co-Author: Nothing to Disclose

Sudha Kiran Das, Abstract Co-Author: Nothing to Disclose

1. TO REDEFINE THE CRITERIA USED TO GRADE VARICOCELES BASED ON REFLUX TIME ON VALSALVA MANOEUVRE AS THE EXISTING RADIOLOGICAL GRADING SYSTEM HAS POOR CORRELATION TO THE CLINICAL GRADING SYSTEM IN USE BY UROSURGEONS. 2. TO OVERCOME THE LIMITATIONS OF CLINICAL GRADING AS IN CONDITIONS LIKE THICK SCROTAL SKIN,  SCARRING, HYDROCELE WHICH RENDER CLINICAL GRADING INACCURATE AND THEREBY AID IN THERAPY. 3. TO INCLUDE THE COMPONENT OF INTRATESTICULAR VARICOCELE IN THE GRADING SYSTEM AS TREATMENT FOR THE SAME VARIES; SO ALSO TO INCREASE THE AWARENESS OF THIS LESS KNOWN ENTITY.  

METHOD: PROSPECTIVE CORRELATIVE STUDY UNDERTAKEN AT JSS HOSPITAL, MYSORE DURING THE PERIOD OF JULY 2009 TO JANUARY 2011. MATERIALS: 1. A SAMPLE OF 100 CONSECUTIVE PATIENTS WITH VARICOCELE WHO WERE CLINICALLY GRADED PRIOR TO THE DUPLEX STUDY WERE ENROLLED. 2. SONOGRAPHIC EXAMINATION OF ALL THE PATIENTS WAS PERFORMED WITH SIEMENS G-60 [SONOLINE] USING 5-10MHz TRANSDUCER IN SUPINE POSITION. 3. VENOUS REFLUX NOTED ON VALSALVA MANOEUVRE WAS MEASURED IN MILLISECONDS AND RESULTS OBTAINED WERE TABULATED. 4. PATIENTS WITH INTRATESTICULAR VARICOCELE WERE NOTED AND THEY WERE SUBGRADED.  

DURING THE PERIOD OF JULY 2009 - JANUARY 2011, 100 PATIENTS WERE EXAMINED AS PER THE METHODOLOGY. THE MEAN REFLUX TIMES OBTAINED AS PER THE CLINICALLY GRADED VARICOCELES WERE AS FOLLOWS: SUBCLINICAL VARICOCELE-800 MILLISECONDS GRADE 1 VARICOCELE-1900 MILLISECONDS GRADE 2 VARICOCELE-3100 MILLISECONDS GRADE 3 VARICOCELE-4500 MILLISECONDS  

BASED ON THE RESULTS OBTAINED, WE PROPOSE A MODIFIED RADIOLOGICAL GRADING OF THE VARICOCELE BASED ON REFLUX TIMES AT VALSALVA MANOEUVRE AS FOLLOWS:- CLINICAL GRADE        MODIFIED RADIOLOGICAL GRADE            REFLUX TIME Subclinical                          Grade 0                                                    Less than 1000ms Grade 1                               Grade 1                                                    1000 to 2500ms Grade 2                               Grade 2                                                    2500 to 4000ms Grade 3                               Grade 3                                                    More than 4000ms PRESENCE OF AN INTRATESTICULAR VARICOCELE WITH ANY OF THE ABOVE GRADES ARE TO SUFFIXED WITH " I "  

GRADING BASED ON REFLUX CORRELATES CLINICALLY AND THEREBY HAS THERAPEUTIC IMPLICATIONS IN ADDITION TO PROVIDING AN OBJECTIVE, ACCURATELY REPRODUCABLE METHOD TO GRADE VARICOCELES WITH REFERENCE TO ITV.

Patil, V, Shety, C, Das, S, Redefining the Criteria for Grading Varicocele Based on Reflux Times: A Clinicoradiological Correlation with Special Reference to Intratesticular Varicocele.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003346.html