Scrotal infrared digital thermography for detection of subclinical varicocele

Varicocele is the condition of abnormal venous dilatation of the pampiniform plexus and scrotal veins with blood reflux. In the literature the association of varicocele with male infertility risk has been described: venous reflux and the following scrotal thermal impairment have a deteriorating effect on spermatogenesis, even when assessed in asymptomatic subjects. Therefore a correct and early diagnosis of varicocele is mandatory. The aim of this study is to emphasize the diagnostic value of scrotal thermography in the investigation of varicocele combined with Color Doppler Ultrasound (CDU), considered the "gold standard" diagnostic tool thanks to its feasibility for measuring venous vessel size and blood flow parameters. 51 young asymptomatic volunteers (age range 18-36 years) underwent clinical examination, scrotal thermography and CDU, after providing informed written consent. Sarteschi classification was used for CDU evaluation. Among subjects, 21 (21/51, 40%) had left unilateral varicocele, detected using CDU; 21% (11/51) presented varicocele grade II, 11% (6/51) grade III and 8% (4/51) grade IV. Scrotal thermography documented an increased temperature and faster recovery of the left hemiscrotum in the same ones; a basal testicular temperature greater than 32°C and basal pampiniform plexus temperature greater than 34°C were considered warning values. Moreover thermal impairment of the left pampiniform plexus was assessed in other four subjects, whose CDU exam showed a higher vessel size (≥ 3 mm) with normal blood flow parameters. Clinical examination, affected by a low sensibility and specificity, showed the presence of left varicocele in only 12 volunteers (12/51, 24%). Our experience confirms that scrotal thermography is a feasible and low cost diagnostic tool for varicocele. Even if CDU remains the method as a reference, thanks to its high sensitivity, we suggest the use of scrotal thermography in screening programme in the assessment of subclinical varicocele.