Numerous classifications are around for grading varioceles. One of the most popular ones used is using gray scale and color doppler ultrasound to classify severity of varicoceles
Classification
Grade 1
- No 2D evidence of scrotal varicosity
- Prolonged reflux in inguinal vessels only during Valsalva
Grade 2
- Small varicosity reaching superior pole of testis, increasing in diameter during Valsalva
- Positive venous reflux in supratesticular region only during Valsalva
Grade 3
- Enlarged veins near inferior pole of testis in standing position.
- Positive reflux only during Valsalva
Grade 4
- Enlarged vessels in supine position
- Dilatation increases in upright position and during Valsalva
- Enhancement of reflux during Valsalva
- Hypotrophy of testis may be seen
Grade 5
- Venous ectasia in supine position
- Basal venous reflux not altering substantially in standing position or during Valsalva
N.B. A combination of gray scale findings and color doppler helps in eluding a more accurate diagnosis. A cut off of 2-3mm cross sectional diameter and / or a reflux of >1 second is pathological.
Sarteschi, L. M., et al. “Lo studio del varicocele con eco-color-Doppler.” G Ital Ultrasonologia 4 (1993): 43-49.