The Investigation of the Relationship Between Semen Analysis and Doppler Ultrasonografic Findings of Reflux Flow in Patients with Subclinical Varicocele

Year 2019, Volume: 46 Issue: 4, 649 - 656, 15.12.2019

Ahmet Vural , Mustafa Salih

https://doi.org/10.5798/dicletip.661224

Abstract

Objective: The aim of the present study was to the measurement of reflux flow volume, velocity and duration with color doppler ultrasonography (CDUS) in subclinical varicocele cases, and comparison of CDUS findings with semen analysis.
Method: 219 infertile men with no clinical overt varicocele are examined with CDUS. 61 people who have vein diameter bigger than 2 mm, or have 1 second or longer reflux flow were classified as subclinical varicocele. CDUS examination is implemented in decubitus position. Reflux flow volume, velocity and duration of reflux in plexus pampiniformis veins were measured bilaterally during Valsalva maneuver.
Results: In subclinical varicocele cases, mean vein diameters were measured mean 2.35 mm while resting, and 2.61 mm during Valsalva maneuver. With Valsalva mean reflux flow volume was 13.56 mL/min, duration was 1.32 sec, flow velocity was 5.6 cm/sec. There were anomaly in semen analysis of 13 of these cases (21.3%). A significant correlation between reflux duration and reflux flow velocity are found. However, no significant relation between reflux flow volume, velocity and duration with semen analysis is detected.
Conclusion: In subclinic varicocele cases, CDUS is a valuable diagonistic procedure that is quite successful on detecting the vein diameter and reflux. No relation was found between reflux flow volume, velocity and duration with semen analysis. However, a study commited with a larger group could give more useful information.

Keywords

Varicocele, Color Doppler Ultrasound

References

• 1. Spencer WG. Celsus de Medicina: with an English translation. Cambridge: Harvard University Press, 1938.
• 2. Noske HD, Weidner W. Varicocele a historical perspective. World J Urol. 1999; 17: 151–7.
• 3. Sakamoto H, Saito K, Shichizyo T, et al. Color Doppler ultrasonography as a routine clinical examination in male infertility. Int J Urol. 2006; 13: 1073–78.
• 4. Gat Y, Zukerman Z, Chakraborty J, Gornish M. Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Hum Reprod. 2005; 20: 2614–19.
• 5. Trussell JC, Haas GP, Wojtowycz A, Landas S, Blank W. High prevalence of bilateral varicoceles confirmed with ultrasonography. Int Urol Nephrol. 2003; 35: 115–8.
• 6. World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril. 1992; 57: 1289–93.
• 7. Kroese ACJ, de Lange NM, Collins J, Evers JLH. Surgery or embolization for varicoceles in subfertile men. Cochrane Database of Systematic Reviews. 2012; 10: CD000479.
• 8. 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: 639–48.
• 9. Abdel-Meguid T, Al-Sayyad A, Tayib A, Farsi HM. Does varicocele repair improve male infertility? an evidence-based perspective from a randomized, controlled trial. Eur Urol. 2011; 59: 455–61.
• 10. World Health Organization: Laboratory manual for the examination and processing of human semen, 5th ed. Geneva: WHO Press, 2010.
• 11. Trum JW, Gubler FM, Laan R, van der Veen F. The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum Reprod. 1996; 11: 1232–35.
• 12. EAU (2010) EAU Guidelines edition presented at the 25th EAU Annual Congress: EAU Guidelines Office, Arnhem, The Netherlands.
• 13. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993; 59: 613-6.
• 14. Hoekstra T, Witt MA. The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. J Urol. 1995; 153: 82–4.
• 15. Cina A, Minnetti M, Pirronti T, et al. Sonographic quantitative evaluation of scrotal veins in healthy subjects: normative values and implications for the diagnosis of varicocele. Eur Urol. 2006; 50: 345–50.
• 16. Orda R, Sayfan J, Manor H, Witz E, Sofer Y. Diagnosis of varicocele and postoperative evaluation using inguinal ultrasonography. Ann Surg. 1987; 206: 99–101.
• 17. Schiff JD, Li PS, Goldstein M. Correlation of ultrasoundmeasured venous size and reversal of flow with Valsalva with improvement in semen-analysis parameters after varicocelectomy. Fertil Steril. 2006; 86: 250–2.
• 18. Kocakoc E, Serhatlioglu S, Kiris A, et al. Color Doppler sonographic evaluation of inter-relations between diameter, reflux and flow volume of testicular veins in varicocele. Eur J Radiol. 2003; 47: 251–6.
• 19. Wolverson MK, Houttuin E, Heiberg E, Sundaram M, Gregory J. High-resolution real-time sonography of scrotal varicocele. AJR Am J Roentgenol. 1983; 141: 775–9.
• 20. Caskurlu T, Tasci AI, Resim S, Sahinkanat T, Ekerbicer H. Reliability of venous diameter in the diagnosis of subclinical varicocele. Urol Int. 2003; 71: 83–6.
• 21. Hussein AF. The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol. 2006; 176: 2141–5.
• 22. Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varicoceles. J Urol. 1996; 155: 1287–90.
• 23. Liguori G, Trombetta C, Garaffa G, et al. Color Doppler ultrasound investigation of varicocele. World J Urol. 2004; 22: 378–81.
• 24. Arslan H, Sakarya ME, Atilla MK. Clinical value of power Doppler sonography in the diagnosis of varicocele. J Clin Ultrasound. 1998; 26: 229.
• 25. Gonda RL, Jr., Karo JJ, Forte RA, O’Donnell KT. Diagnosis of subclinical varicocele in infertility. Am J Roentgenol. 1987; 148: 71-5.
• 26. Chiou RK, Anderson JC, Wobig RK, et al. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1997; 50: 953-6.
• 27. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970; 21: 606-9.
• 28. Vivas-Acevedo G, Lozano JR, Camejo MI. Effect of Varicocele Grade and Age on Seminal Parameters. Urol Int. 2010; 85: 194-9.
• 29. Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. J Urol. 2006; 176: 2602–5.
• 30. Richardson I, Nagler HM. Is bilateral varicocele more detrimental to male fertility than unilateral varicocele? Nat Clin Pract Urol. 2007; 4: 366–7.