{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:13:36Z","timestamp":1792642416877,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T00:00:00Z","timestamp":1590451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the diagnostic accuracy of PE to color Doppler ultrasonography (CDU) for the diagnosis of varicocele in experienced and non\u2010experienced examiners.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Diagnostic accuracy study involving 78 patients attending a university\u2010based infertility unit. Patients underwent scrotal PE by both experienced (over 10\u00a0years experience in male infertility) and non\u2010experienced 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010experienced urologists (82.0% CI: 74.27\u201088.26 and 81.1% CI: 74.39\u201086.44% vs 67.2% CI: 58.33\u201075.22 and 70.6% CI: 64.52\u201076.08, respectively). Agreements on varicocele diagnosis (<jats:italic>k:<\/jats:italic> 0.625 vs 0.517) and grading (<jats:italic>k:<\/jats:italic> 0.548 vs 0.418) by PE were higher among experienced than non\u2010experienced urologists. Differences between eutrophic and overweight\/obese patients were also suggested.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and conclusions<\/jats:title><jats:p>PE performed by infertility specialists identify patients with varicocele more precisely than non\u2010specialists. 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.12797","type":"journal-article","created":{"date-parts":[[2020,4,14]],"date-time":"2020-04-14T19:09:33Z","timestamp":1586891373000},"page":"1160-1166","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Diagnostic accuracy of physical examination compared with color Doppler ultrasound in the determination of varicocele diagnosis and grading: Impact of urologists\u2019 experience"],"prefix":"10.1111","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5465-4304","authenticated-orcid":false,"given":"Marcello S.","family":"Cocuzza","sequence":"first","affiliation":[{"name":"Departamento de Urologia Faculdade de Medicina Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4497-2971","authenticated-orcid":false,"given":"Bruno C.","family":"Tiseo","sequence":"additional","affiliation":[{"name":"Departamento de Urologia Faculdade de Medicina Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil"},{"name":"Hospital Israelita Albert Einstein S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8346-3833","authenticated-orcid":false,"given":"Victor","family":"Srougi","sequence":"additional","affiliation":[{"name":"Departamento de Urologia Faculdade de Medicina Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3712-4843","authenticated-orcid":false,"given":"Guilherme J. A.","family":"Wood","sequence":"additional","affiliation":[{"name":"Departamento de Urologia Faculdade de Medicina Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0066-4619","authenticated-orcid":false,"given":"Joao P. G. F.","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Departamento de Urologia Faculdade de Medicina Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1313-9680","authenticated-orcid":false,"given":"Sandro C.","family":"Esteves","sequence":"additional","affiliation":[{"name":"ANDROFERT Andrology and Human Reproduction Clinic Campinas Brazil"},{"name":"Department of Surgery (Division of Urology) University of Campinas (UNICAMP) Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Srougi","sequence":"additional","affiliation":[{"name":"Departamento de Urologia Faculdade de Medicina Hospital das Clinicas HCFMUSP Universidade de Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.04.048"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2014.10.007"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.08.029"},{"key":"e_1_2_7_5_1","first-page":"CD000479","article-title":"Surgery or embolization for varicoceles in subfertile men","volume":"10","author":"Kroese AC","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.humrep.a019362"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000138540.57137.5f"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-011-0701-4"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2042.2001.00289.x"},{"key":"e_1_2_7_10_1","volume-title":"Sample Size Calculations on Clinical Trials","author":"Chow S\u2010C","year":"2008"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)37684-1"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.1991.tb15148.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(97)00452-4"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2005.12.038"},{"key":"e_1_2_7_15_1","first-page":"360","article-title":"Understanding interobserver agreement: the kappa statistic","volume":"37","author":"Viera AJ","year":"2005","journal-title":"Fam Med"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","unstructured":"HamadaA EstevesSC AgarwalA.Varicocele Classification. 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