Table 1.

Color Doppler ultrasound (CDU) classification of varicocele.

Grade	Features
1	Reflux in vessels in the inguinal channel is detected only during the Valsalva maneuver, while scrotal varicosity is not evident in the standard US study
2	Small posterior varicosities that extend to the superior pole of the testis. Their diameters increase and venous reflux is seen in the supratesticular region only during the Valsalva maneuver.
3	Vessels appear enlarged at the inferior pole of the testis when the patient is evaluated in a standing position; no enlargement is detected if the patient is examined in a supine position. Reflux observed only under during the Valsalva maneuver.
4	Vessels appear enlarged even when the patient is studied in a supine position; the dilatation is more marked in the upright position and during the Valsalva maneuver. Testicular hypotrophy is common at this stage.
5	Venous ectasia is evident even in the prone decubitus and supine positions. Reflux is observed at rest and does not increase during the Valsalva maneuver.