Varicocele grading on color Doppler can be done variably. The most elaborate and widely-accepted grading was given by Sarteschi, as below. 

For a general discussion of this condition refer to the article: varicocele.

Evaluation

1. baseline greyscale study in supine position and measure the diameters of veins, as well as the total diameter of the plexus

2. next, do color Doppler interrogation and see reflux during Valsalva maneuver

3. repeat in standing position

Grading of varicocele

• grade I

  • no dilated intrascrotal veins

  • reflux in spermatic cord veins of the inguinal region during Valsalva maneuver

• grade II

  • prominent veins at upper pole of testis

  • reflux at upper pole veins during Valsalva maneuver

• grade III

  • no major dilatation in supine position

  • dilated veins up to lower pole of testis seen only in standing position

  • reflux at lower pole veins during Valsalva maneuver

• grade IV

  • dilated veins even in supine position

  • reflux during Valsalva maneuver

• grade V

  • dilated veins

  • reflux without Valsalva maneuver

Classification according to Sarteschi ¹

• grade I: reflux at the level of groin only during the Valsalva maneuver, without scrotal deformation or testicular hypotrophy

• grade II: reflux at the level of the proximal segment of the pampiniform plexus only during the Valsalva maneuver, without scrotal deformation or testicular hypotrophy

• grade III: reflux in the distal vessels at the level of lower scrotum only during the Valsalva maneuver, without scrotal deformation or testicular hypotrophy

• grade IV: spontaneous reverse flow, increasing during the Valsalva maneuver, with scrotal deformation and possible testicular hypotrophy

• grade V: resting reflux in the dilated pampiniform plexus, possibly increasing during the Valsalva maneuver, always accompanied by testicular hypotrophy