The effect of varicocele on the right testicular blood flow in patients with left varicocele

Öz

Objective: There are many theories about the mechanism how varicocele causes infertility. One of these theories is about the negative effect of varicocele on testicular blood flow. We aimed to compare the measurements of testicular blood flow in right and left testes in patients with left varicocele and normal right testes. Methods: Forty-one patients with left varicocele were enrolled in the study. All participants were performed color Doppler sonography to assess testicular blood flow of the both testes. Blood flow parameters such as peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), pulsatility index (PI) were measured in testicular, capsular and intratesticular arteries. Semen parameters were also assessed in the participants. Testicular blood flow parameters were compared between the two testes. Results: Mean age of the patients was 25,95±5,27(16-37). The mean semen parameters of the patients; sperm count (million/ml) was 31.56±19.05, motility (%) was 51.21±22.27, normal morphology (%) was 12.75±2.97 and total motile sperm count (million/ml) was 54.92±47.46. There were no statistically significant differences between the testicular blood flow parameters of both testes which are PSV, EDV, RI and PI values in the testicular artery and its branches (capsular and intratesticular arteries)(p>0.05). Conclusion: The fact that there were no differences between the blood flows in both testes may depend on the study group who had normal sperm parameters. We suggest that testicular blood flow may be evaluated in patients with left varicocele and impaired sperm parameters.

Anahtar Kelimeler

• testicular blood flow, color Doppler ultrasound, varicocele

The effect of varicocele on the right testicular blood flow in patients with left varicocele

Öz

Amaç: Varikosel hastalarında görülen sperm parametre bozukluğu hakkında çok sayıda teori ileri sürülmüştür. Bu teorilerden biri de, testisin arteriyel kan akımındaki değişikliklerdir. Biz çalışmamızda; sol varikoseli ve normal sağ testisi olan hastaların sağ ve sol testislerindeki arteriyel kan akım değerlerini karşılaştırmayı amaçladık. Yöntemler: Üroloji polikliniğine başvuran ve fizik muayenesinde sol varikosel saptanan 41 erkek çalışmaya alındı. Sağ ve sol testislerindeki kan akımını değerlendirmek için tüm hastalara renkli doopler ultrason yapıldı.Her iki testisteki testiküler, kapsüler ve intratestiküler arterlerdeki pik sistolik hız, end diyastolik hız, resisitive ve pulsatilite indeksleri ölçüldü. Semen parametreleri de ayrıca değerlendirildi. Her iki testisin kan akım değerleri karşılaştırıldı. Bulgular: Çalışmaya katılan hastaların yaş ortalaması 25,95±5,27(16-37) idi. Tüm hastaların sperm parametre ortalamaları; ml\'deki sayı(milyon) 31,56±19,05, hareket(%) 51,21±22,27, morfoloji(%) 12,75±2,97 ve total motil sperm sayısı 54,92±47,46 olarak belirlendi. Testiküler arter ile bu arterin testis içindeki dalları olan kapsüler ve parankimal arterlerin pik sistolik hızları, diastol sonu hızları, direnç ve pulsatilite indeksleri arasında her iki testis karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı(p>0,05). Sonuç: Sağ ve sol testiküler akım değerlerinde anlamlı bir farklılık saptanmaması, çalışmanın sperm parametreleri normal sınırlarda olan bir grupla yapılmasına bağlanabilir. Sperm parametreleri etkilenmiş başka bir sol varikoselli hasta grubuyla karşılaştırmalı olarak yapılacak yeni çalışmalara gereksinim duyulmaktadır.

Anahtar Kelimeler

• testiküler kan akımı, renkli Doppler ultrason, varikosel

Kaynakça

1. Noske HD, Weidner W. Varicocele--a historical perspective. World J Urol 1999;17:151–157.
2. Nagler HM, Luntz RK, Martinis FG. Varicocele. In: Lipshultz LI, Howards SS, eds. Infertility in the Male. 3rd ed. St Lou- is, Missouri: Mosby-Year Book; 1997:336–359.
3. Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology 1993;42:541–543.
4. Tarhan S, Gumus B, Gunduz I, et al. Effect of varicocele on testicular artery blood flow in men-color Doppler investiga- tion. Scand J Urol Nephrol 2003;37:38–42.
5. Balci A, Karazincir S, Gorur S, et al. Longterm effect of vari- cocele repair on intratesticular arterial resistance index. J Clin Ultrasound 2008;36:148–152.
6. Eisenberg ML, Lipshultz LI. Varicocele-induced infertil- ity: Newer insights into its pathophysiology. Indian J Urol 2011;27:58–64.
7. Gat Y, Zukerman Z, Chakraborty J, Gornish M. Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system. Hum Re- prod 2005;20:2614-2619
8. Akcar N, Turgut M, Adapinar B, Ozkan IR Intratesticular ar- terial resistance and testicular volume in infertile men with subclinical varicocele. J Clin Ultrasound 2004;32:389-393.

9. Eskew LA, Watson NE, Wolfman N, et al. Ultrasonographic diagnosis of varicoceles. Fertil Steril 1993;60:693.
10. Hassan A, Gad HM, Mostafa T. Radiologically assessed tes- ticular changes in infertile males with varicocele. Androlo- gia 2011;43:307-311.
11. Sweeney TE, Rozum JS, Gore RW. Alteration of testicular microvascular pressures during venous pressure elevation. Am J Physiol 1995;269:37–45.
12. Hudson RW. The endocrinology of varicoceles. Fertil Steril 1988;49:199–208.
13. WHO laboratory manual for the examination of human se- men and sperm-cervical mucus interaction, 4th ed. Cam- bridge, UK: Cambridge University Press 1999;10:128.
14. Trum JW, Gubler FM, Laan R, van der Veen F. The value of palpation, varicoscreen contact, thermography and color Doppler ultrasound in the diagnosis of varicocele. Hum Re- prod 1996;11:1232-1235
15. Lund L, Roebuck DJ, Lee KH, et al. Clinical assesment after varicocelectomy. Scand J Urol Nephrol 2000;34:119- 122.
16. Tarhan S, Ucer O, Sahin MO, Gumus B. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow. J Androl 2011;32:33-39.
17. McClure D, Khoo D, Jarvi K, Hricak H. Subclinical varicocele: the effectiveness of varicocelectomy. J Urol 1991;145:789–791.
18. Unsal A, Turgut AT, Taşkin F, et al. Resistance and pulsatil- ity index increase in capsular branches of testicular artery: indicator of impaired testicular microcirculation in varico- cele? J Clin Ultrasound. 2007;35:191-195.