(559) Varicocele Under the Probe: A National Multicentre Evaluation of Ultrasound Reporting Practices Across UK NHS Centres

Abstract Introduction A varicocele is an abnormal dilatation of the pampiniform plexus and represents the most common correctable cause of male infertility. It affects approximately 15–20% of all men and up to 40% of those with infertility. Surgical repair of clinically significant varicoceles has been shown to improve semen parameters and pregnancy rates. As such, accurate and standardised ultrasonographic assessments are essential to aid in better understanding the magnitude of dilatation and how it implicates subsequent surgical and fertility outcomes. In 2022, the European Society of Urogenital Radiology–Scrotal and Penile Imaging Working Group (ESUR-SPIWG) published guidelines on the optimal ultrasound evaluation and grading of varicocele practices. Objective This study aims to evaluate compliance with ESUR-SPIWG ultrasound reporting standards for varicocele assessment across multiple National Health Service (NHS) centres and to identify areas for improvement to inform future national standardisation and prospective research utilisation. Methods A multicentre retrospective study was conducted across 14 NHS centres, with each site reviewing 30 scrotal ultrasounds using a standardised assessment tool published by the ESUR-SPIWG. The reports were evaluated for: a) Testicular volume measurements b) Location, laterality and diameter of the largest vein in both supine and erect positions. c) Level and duration of venous reflux in both positions. d) Operator designation. The collected data was then pooled, and descriptive statistical analyses was performed using Microsoft Excel & Statistical Package for Social Sciences (SPSS) v29. Results A total of 420 ultrasound reports were analysed and compared against the ESUR-SPIWG guideline. Testicular volume was reported in 28.8% of the scans, whereas the largest vein’s location & size were reported in 14% and 49% of the scans with the patient supine, and 0.7% and 0.2% with the patient standing. Most of the scans did not have both scanning positions reported concurrently. Only 5% of the scans reported the level of the venous reflux with the patient supine, whereas venous reflux with the patient standing, reflux position and duration were not reported in any scans. Around 35% of the scans reported refluxing, albeit with no description of reflux duration or positional changes. In fact, patient positioning was not reported in 92% of the scans. No clear utility of a known classification system was noted (i.e. Sarteschi) in most reports. Full compliance with the ESUR-SPIWG standards was not achieved by any of the scans analysed. Most scans clearly described their designated operator. Conclusions This national multicentre study demonstrates widespread non-compliance with ESUR-SPIWG ultrasound reporting standards. Core compliance parameters including testicular volume calculation, positional venous assessment, and reflux position & duration are frequently omitted. To address these gaps, implementing a standardised reporting proforma and promoting guideline-based education are recommended, with re-audit to assess progress, enhance national consistency, and support clinical practice & future research. Disclosure No