varicocele

With Doppler ultrasonography, 2 types of retrograde flow in varicoceles have been described. These include the shunt-type varicocele and the stop-type varicocele (see Image below and Image 6 in Multimedia).10 The shunt-type varicocele occurs in 86% of patients and is associated with diminished sperm quality as well as with a medium to large varicocele. The stop-type varicocele involves reflux, which is only brief, and the sperm quality is normal and associated with a subclinical varicocele. Shunt-type Doppler flow occurs because insufficient distal valves allow spontaneous and continuous reflux from the internal spermatic vein into the cremasteric vein and the vein of the vas deferens via collateral vessels. The stop type of flow, also known as the pressure type, occurs in patients with intact intrascrotal valves. This type allows only a brief period of reflux from the spermatic vein into the pampiniform plexus when a Valsalva maneuver is performed.