1. Doppler USS—can confirm diagnosis and grading. All grade III varicoceles should undergo USS of the retroperitoneum to exclude obstruction of the testicular vein (e.g., from a renal tumor, retroperitoneal nodes).
2. Venography—in some centers, venography is preferred for demonstration of varicocele anatomy. This has been the traditional gold standard investigation, but due to its invasive nature (requires access through either the common femoral or internal jugular vein), it has been superseded by USS.
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