Presentation Authors: Mohit Butaney*, Jabez Gondokusumo, Alexander J. Tatem, Jonathan A. Beilan, Nannan Thirumavalavan, Houston, TX, Alexander W. Pastuszak, Salt Lake City, UT, Larry I. Lipshultz, Houston, TX
Introduction: Ultrasound (US) is commonly utilized by urologists for its ability to noninvasively detect pathology with minimal cost. We aim to assess practice patterns of male reproductive urologists using US to evaluate varicoceles.
Methods: An IRB-approved anonymous survey was sent to members of Society for Male Reproduction and Urology (SMRU). The survey included questions on respondent demographics, including practice location and type. We asked respondents about their protocols for scrotal US, specifically regarding evaluation of varicoceles. Responses were collected and tabulated using Survey Monkey (San Mateo, California, USA). Chi-square test was used to determine association between categorical variables.
Results: Of the 320 people who were sent the survey, 101 (31.6%) responded. Of these, 62 reported using or performing scrotal US and completed the survey. Respondents (93.4%) were attending urologists or resident/fellow urologists (6.6%) practicing in the USA (85.5%), with 87.1% having completed a fellowship in Andrology/Sexual Medicine/ Male Infertility. Of the cohort, 38.7% perform their own ultrasounds compared to the remainder who have either the radiology department or a technician performing the US. When performing their own US, 84% of respondents measure venous diameters for varicoceles, compared to 76% when a 3rd party is performing the US. For those not performing their own ultrasound, 1.8% were unsure whether the US technician looks for varicoceles, 8.9% were unsure whether venous diameters were measured in varicoceles, and 16.1% were unsure of patient position (standing vs supine, Valsalva or not) during the US. A high degree of variability was observed in venous diameter defining a varicocele (range 2-4 mm). In addition, comments made by respondents included 'For radiology, any vein that dilates with Valsalva and has retrograde flow or is 3mm or larger', 'any vein is called a varicocele', and 'change in baseline > 2mm with Valsalva.' Though 80% of respondents assess retrograde flow during the US, only 54% reported that retrograde flow was required to diagnose a varicocele (p < 0.01).
Conclusions: Providers use a wide range of radiographic diagnostic criteria for varicoceles. This variability limits both our ability to determine what truly represents a varicocele and warrants repair, as well as our ability to objectively evaluate the varicocele literature. Further research should focus on standardizing definitions of varicoceles detected by US.
Source of Funding: This work is supported in part by NIH grant K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program (NT is a K12 Scholar). A.W.P. is a National Institutes of Health K08 Scholar supported by a Mentored Career Developmen