Sarteschi grading of varicocele

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


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.