Ultrasound Evaluation and Grading of Varicoceles: A Two-Cycle Clinical Audit.

Abstract

Introduction Varicoceles are a common cause of male infertility, and ultrasound (US) is the primary imaging modality used for diagnosis and grading. However, variability in reporting practices can hinder clinical decision-making. This clinical audit aimed to improve adherence to standardized US reporting guidelines for varicoceles, as recommended by the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) and the Royal College of Radiologists (RCR). Materials and methods A two-cycle retrospective clinical audit was conducted in Manchester University NHS Foundation Trust. Testicular US reports were assessed before and after a targeted intervention that included a multidisciplinary meeting and the implementation of a structured reporting template. Reports were evaluated against ESUR-SPIWG and RCR guidelines, focusing on documentation of testicular volume, varicocele location, largest vein diameter, reflux assessment, and varicocele grading using the Sarteschi classification. Statistical analysis was performed using the chi-square test. Results A total of 66 testicular US reports were reviewed across two audit cycles. Statistically significant improvements were observed post-intervention in the documentation of key parameters (all p < 0.001): testicular volume (0.0% to 91.6%), varicocele location (0% to 91.6%), largest vein diameter (50.0% to 100%), and Valsalva/varicocele grading (0% to 97.2%). Conclusions The introduction of a structured reporting template and interdisciplinary collaboration significantly improved compliance with international varicocele US reporting standards. This approach enhances diagnostic quality and supports more effective urological triage. The findings suggest a scalable model for broader adoption and future integration into electronic systems, promoting consistency, auditability, and improved patient outcomes.