Diagnostic accuracy of physical examination compared with color Doppler ultrasound in the determination of varicocele diagnosis and grading: Impact of urologists’ experience

Autor:	Bruno Camargo Tiseo, Guilherme J. A. Wood, Sandro C. Esteves, Miguel Srougi, Marcello Cocuzza, Joao Paulo Cardoso, Victor Srougi
Rok vydání:	2020
Předmět:	Adult Male Infertility medicine.medical_specialty Urology Endocrinology Diabetes and Metabolism Varicocele Physical examination Subgroup analysis Overweight Male infertility 03 medical and health sciences 0302 clinical medicine Endocrinology Cohen's kappa medicine Humans Ultrasonography Doppler Color Physical Examination Grading (tumors) 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry medicine.disease Reproductive Medicine Clinical Competence Radiology medicine.symptom business
Zdroj:	Andrology. 8:1160-1166
ISSN:	2047-2927 2047-2919
DOI:	10.1111/andr.12797
Popis:	Background Treatment of palpable varicocele in infertile men with abnormal semen parameters is widely accepted, and physical examination (PE) remains a cornerstone for recommending varicocele repair. However, identification of clinical varicocele during PE can be challenging for both urology residents and consultants. Objective To compare the diagnostic accuracy of PE to color Doppler ultrasonography (CDU) for the diagnosis of varicocele in experienced and non-experienced examiners. Materials and methods Diagnostic accuracy study involving 78 patients attending a university-based infertility unit. Patients underwent scrotal PE by both experienced (over 10 years experience in male infertility) and non-experienced urologists (senior residents), and were subjected to CDU. varicocele diagnosis and varicocele grading were compared between examiner groups and to CDU. Accuracy measures were evaluated, and interobserver agreement was estimated using unweighted kappa statistics. A subgroup analysis for normal and high body mass index (BMI) was also performed for the same variables. Results Accuracy of PE for varicocele diagnosis was 63.5% with a positive predictive value (PPV) of 75.5%. The specificity and PPV of PE were higher among experienced than non-experienced urologists (82.0% CI: 74.27-88.26 and 81.1% CI: 74.39-86.44% vs 67.2% CI: 58.33-75.22 and 70.6% CI: 64.52-76.08, respectively). Agreements on varicocele diagnosis (k: 0.625 vs 0.517) and grading (k: 0.548 vs 0.418) by PE were higher among experienced than non-experienced urologists. Differences between eutrophic and overweight/obese patients were also suggested. Discussion and conclusions PE performed by infertility specialists identify patients with varicocele more precisely than non-specialists. However, PE alone has suboptimal accuracy for varicocele diagnosis. Our results indicate that PE should be followed by CDU to decrease the number of false positives and increase the diagnostic accuracy of varicocele diagnosis.
Databáze:	OpenAIRE
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