Contribution of pre-varicocelectomy color Doppler ultrasonography finding to surgery and its correlation with semen parameters
https://doi.org/10.4081/aiua.2021.2.227
Accepted: February 3, 2021
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background: This study aimed to determine the contribution of color Doppler ultrasonography (CDUS) performed before varicocelectomy to the success of surgical treatment and to evaluate the correlation between CDUS findings and semen parameters.
Methods: A total of 84 patients diagnosed with grade 3 left varicocele in our clinic between 2016 and 2018 were evaluated. The patients in whom the decision for varicocelectomy was based on only physical examination (PE) findings and abnormal semen analysis (SA) were defined as Group 1, while the patients undergoing varicocelectomy based on PE, CDUS and SA findings were defined as Group 2. The patients diagnosed with varicocele based on PE and CDUS findings who were included in a followup protocol due to normal semen parameters were defined as Group 3.
Results: In Group 1, there was a total of 28 patients and the mean number of ligated internal spermatic veins was 4.53 (range, 2-10). In Group 2, there was a total of 30 patients and the number of ligated internal spermatic veins was 3.76 (range, 1-8). No statistically significant difference was found between Group 1 and 2 in terms of the number of internal spermatic veins ligated during varicocelectomy. No statistically significant correlation was found between semen parameters and the number of veins ligated during varicocelectomy in Group 1 and 2 and between semen parameters and CDUS findings group 2 and 3.
Conclusions: In patients with primary grade 3 varicocele, diagnosed by physical examination there is no need for additional imaging in primary cases.
Leslie SW, Sajjad H, Siref LE. Varicocele. StatPearls. Treasure Island (FL); 2019.
Youssef T, Abd-Elaal E, Gaballah G, et al. Varicocelectomy in men with nonobstructive azoospermia: is it beneficial? Int J Surg. 2009; 7:356-360. DOI: https://doi.org/10.1016/j.ijsu.2009.05.009
Esteves SC, Miyaoka R, Roque M, et al. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl. 2016; 18:246-253. DOI: https://doi.org/10.4103/1008-682X.169562
Zampieri N, Bosaro L, Costantini C, et al. Relationship between testicular sperm extraction and varicocelectomy in patients with varicocele and nonobstructive azoospermia. Urology. 2013; 82:74-77. DOI: https://doi.org/10.1016/j.urology.2013.03.037
Kizilay F, Altay B. Evaluation of the effects of antioxidant treatment on sperm parameters and pregnancy rates in infertile patients after varicocelectomy: a randomized controlled trial. Int J Impot Res. 2019; 31:424-431. DOI: https://doi.org/10.1038/s41443-018-0109-4
Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007; 88:639-648. DOI: https://doi.org/10.1016/j.fertnstert.2006.12.008
Hassanin AM, Ahmed HH, Kaddah AN. A global view of the pathophysiology of varicocele. Andrology. 2018; 6:654-661. DOI: https://doi.org/10.1111/andr.12511
Leslie SW, Siref LE. Varicocele. StatPearls. Treasure Island (FL); 2018.
Lomboy JR, Coward RM. The Varicocele: Clinical Presentation, Evaluation, and Surgical Management. Semin Intervent Radiol. 2016; 33:163-169. DOI: https://doi.org/10.1055/s-0036-1586143
Owen RC, McCormick BJ, Figler BD, et al. A review of varicocele repair for pain. Transl Androl Urol. 2017; 6:S20-S29. DOI: https://doi.org/10.21037/tau.2017.03.36
Raghavendran M, Venugopal A, Kiran Kumar G. Thrombosed varicocele - a rare cause for acute scrotal pain: a case report. BMC Urol. 2018; 18:34. DOI: https://doi.org/10.1186/s12894-018-0347-2
Shiraishi K, Takihara H, Naito K. Testicular volume, scrotal temperature, and oxidative stress in fertile men with left varicocele. Fertil Steril. 2009; 91:1388-1391. DOI: https://doi.org/10.1016/j.fertnstert.2008.04.044
Garolla A, Torino M, Miola P, et al. Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod. 2015;30:1006-1013. DOI: https://doi.org/10.1093/humrep/dev057
Gat Y, Bachar GN, Zukerman Z, et al. Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities. J Urol. 2004; 172:1414-1417. DOI: https://doi.org/10.1097/01.ju.0000138540.57137.5f
Preutthipan S, Nicholas OA. Comparative study between scrotal physical examination and scrotal ultrasonography in the detection of varicocele in men with infertility. J Med Assoc Thai. 1995; 78:135-139.
Pryor JL, Howards SS. Varicocele. Urol Clin North Am. 1987; 14:499-513. DOI: https://doi.org/10.1016/S0094-0143(21)01755-9
Macey MR, Owen RC, Ross SS, et al. Best practice in the diagnosis and treatment of varicocele in children and adolescents. Ther Adv Urol. 2018; 10:273-282. DOI: https://doi.org/10.1177/1756287218783900
Cimador M, Di Pace MR, Peritore M, et al. The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents. BJU Int. 2006; 97:1291-1297. DOI: https://doi.org/10.1111/j.1464-410X.2006.06186.x
Tyloch JF, Wieczorek AP. Standards for scrotal ultrasonography. J Ultrason. 2016; 16:391-403. DOI: https://doi.org/10.15557/JoU.2016.0039
Kim YS, Kim SK, Cho IC, et al. Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis. Korean J Urol. 2015; 56:144-149. DOI: https://doi.org/10.4111/kju.2015.56.2.144
Karami M, Mazdak H, Khanbabapour S, et al. Determination of the best position and site for color Doppler ultrasonographic evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically. Adv Biomed Res. 2014; 3:17. DOI: https://doi.org/10.4103/2277-9175.124647
Bagheri SM, Khajehasani F, Iraji H, et al. A Novel Method for Investigating the Role of Reflux Pattern in Color Doppler Ultrasound for Grading of Varicocele. Sci Rep. 2018; 8:6517. DOI: https://doi.org/10.1038/s41598-018-24890-2
Annoni F, Colpi GM, Marincola FM, et al. Doppler examination in varicocele. A standard method of evaluation. J Androl. 1988; 9:248-252. DOI: https://doi.org/10.1002/j.1939-4640.1988.tb01046.x
Sharlip I, Jarow J, Bekler A. AUA Best practice policy. Report on varicocele and infertility American Urological Association Inc, Baltimore, MD, USA 2001.
Borruto FA, Impellizzeri P, Antonuccio P, et al. Laparoscopic vs open varicocelectomy in children and adolescents: review of the recent literature and meta-analysis. J Pediatr Surg. 2010; 45:2464-2469. DOI: https://doi.org/10.1016/j.jpedsurg.2010.07.007
Mahdavi A, Heidari R, Khezri M, et al. Can ultrasound findings be a good predictor of sperm parameters in patients with varicocele? A cross-sectional study. Nephrourol Mon. 2016; 8:e37103. DOI: https://doi.org/10.5812/numonthly.37103
McCullough A, Elebyjian L, Ellen J, et al. A retrospective review of single-institution outcomes with robotic-assisted microsurgical varicocelectomy. Asian J Androl. 2018; 20:189-194. DOI: https://doi.org/10.4103/aja.aja_45_17
Al-Kandari AM, Khudair A, Arafa A, et al. Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis. Arab J Urol. 2018; 16:181-187. DOI: https://doi.org/10.1016/j.aju.2017.12.002
Cho CL, Ho KL, Chan WK, et al. Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience. Int Braz J Urol. 2017; 43:974-979. DOI: https://doi.org/10.1590/s1677-5538.ibju.2017.0107
Cayan S, Kadioglu TC, Tefekli A, et al. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology. 2000; 55:750-754. DOI: https://doi.org/10.1016/S0090-4295(99)00603-2
Belani JS, Yan Y, Naughton CK. Does varicocele grade predict vein number and size at microsurgical subinguinal repair? Urology. 2004; 64:137-139. DOI: https://doi.org/10.1016/j.urology.2004.02.006
Babai M, Gharibvand MM, Momeni M, et al. Comparison of preoperative and post-operative (varicocelectomy) sperm parameters in patients suffering varicocle with and without reflux in Doppler ultrasonography. J Family Med Prim Care. 2019; 8:1730-1734. DOI: https://doi.org/10.4103/jfmpc.jfmpc_170_19
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
