Standing Ultrasound Adds Clinical Utility for the Diagnosis of Varicoceles

We assessed the role of standing vs supine scrotal ultrasound (SUS) for varicocele assessment by evaluating differences in clinical outcomes.We retrospectively reviewed men from 2008-2020 diagnosed with varicocele who had documented SUS with both supine and standing assessments with and without Valsalva. Clinical outcomes (semen parameters, TUNEL and serum testosterone [T]) after microsurgical varicocelectomy were compared among men who had varicoceles diagnosed by standing SUS (vein size2.5 mm, vein size3.0 mm or reversal of flow) to those who would have been missed on supine SUS only.A total of 349 men underwent varicocelectomy (right: 5 [1.4%]; left: 118 [33.8%]; bilateral: 226 [64.8%]). Disagreement between those with abnormal standing vs normal supine for vein size2.5 mm was: 56 men (16.1%) on the right and 31 men (8.9%) on the left, for vein size3.0 mm was: 64 men (18.3%) on the right, and 56 men (16.1%) on the left, and for flow reversal was: 36 (14.0%) on the right and 40 (15.4%) on the left. For those2.5 mm, only T had significant improvements on the left (p=0.05). For those3.0 mm significant differences were seen for sperm motility on the right (p=0.04), and TUNEL (p=0.04) and T (p0.01) on the left. For flow reversal, significant differences were seen for sperm concentration (p0.01), morphology (p=0.03) and volume (p=0.05) on the right and TUNEL on the left (p=0.02).Standing SUS identifies a greater number of men who would have been missed using supine SUS only.