Varikosel Hastalarında Klinik, Laboratuvar ve Doppler Ultrasonografi Bulgularının Değerlendirilmesi

Yıl 2016, Cilt: 3 Sayı: 2, 52 - 58, 31.05.2016

Muammer Akyol Tülin Öztürk Gülen Burakgazi Hanefi Yıldırım İrfan Orhan

Öz

Klinik olarak varikosel tanısı konulan olgularda ve sağlıklı erkeklerde: renkli Doppler ultrasonografi bulgularının, testis hacimlerinin, sperm
yoğunluğu-hareketinin, hormon seviyelerinin ve rezistivite-pulsatilite index’lerinin değerlendirilmesi hedeflendi. Yöntem: Bu çalışmaya fizik muayene ile
varikosel tanısı konulan 100 olgu ve kontrol grubu olarak 20 sağlıklı kişi dahil edildi. Olguların fizik muayenesi yapıldıktan sonra gri skala-Doppler
ultrasonografi, semen ve hormon analizi tetkikleri değerlendirildi. Bulgular: Doppler ultrasonografinin, subklinik varikosel tanısında önemli yeri olduğu ve
klinik olarak varikosel tanısı alan olgularda fizik muayene ile benzer tanısal etkinliği olduğu saptandı. Hasta grupta testis hacimlerinin ve sperm sayıhareketinin azaldığı bulundu (p<0.05). Varikosel hastalarının çoğunluğunda Folikül-stimüle edici hormon ve Testosteron seviyeleri normal olarak bulundu.
Testiküler arter rezistivite-pulsatilite index’lerinde anlamlı değişiklik saptanmadı (p>0.05). Sonuç: Varikosel tanısında fizik muayene ve renkli Doppler
ultrasonografi birlikte uygulanmalıdır. Özellikle subklinik varikosel tanısında renkli Doppler ultrasonografi daha değerli bilgiler vermektedir. Testis
hacimlerine ve spermatogeneze varikoselin olumsuz etkisi olmaktadır

Anahtar Kelimeler

Varikosel, Fizik muayene, Renkli Doppler ultrasonografi, Testis hacmi, Semen analizi., Varikosel, Fizik muayene, Renkli Doppler ultrasonografi, Testis hacmi, Semen analizi.

Evaluation of Clinical, Laboratory and Doppler Ultrasonography Findings in Patients with Varicocele

Öz

To evaluate the color Doppler ultrasonography findings, testicular volumes, sperm concentration-motility, hormone levels and resistivitypulsatility index values of testicular arteries in clinically diagnosed varicocele cases with healthy males. Materials and Methods: This study was
conducted on 100 case subjects with varicocele diagnosis made by physical examination and a healthy control group of 20 volunteers. After the physical
examination of case subjects were done: gray scale-color Doppler ultrasonography, semen analysis and hormone analysis of the subjects were made and
the results were evaluated. Results: It was found that color Doppler ultrasonography has an important role in detection of subclinical varicocele. For
clinically diagnosed cases of varicocele, the results of color Doppler ultrasonography was similar to physical examination. It was detected that testicular
volumes and sperm count-motility were decreased in the patient group (p<0.05). In majority of varicocele case subjects, the follicle-stimulating hormone
and testosterone levels were found normal. No significant change was detected in the values of resistivity-pulsatility index in testicular arteries (p>0.05).
Conclusion: In varicocele diagnosis, physical examination and color Doppler ultrasonography should be performed together. Particularly in subclinical
varicocele diagnosis, color Doppler ultrasonography is useful. Adverse effect of varicocele on testicular volumes and spermatogenesis was detected.
Keywords: Varicocele, physical examination, color Doppler ultrasonography, testicular volume, semen analysis

Anahtar Kelimeler

Varicocele, physical examination, color Doppler ultrasonography, testicular volume, semen analysis.

Kaynakça

• 1.Naughton CK, Nangia AK, Agarwal A. Pathophysiology of varicoceles in male infertility. Hum Reprod Update 2001;7:473–81.
• 2. Rodriguez Peña M, Alescio L, Russell A, Lourenco da Cunha J, Alzu G, Bardoneschi E. Predictors of improved seminal parameters and fertility after varicocele repair in young adults. Andrologia 2009;41:277–81.
• 3. Kocakoc E, Serhatlioglu S, Kiris A, Bozgeyik Z, Ozdemir H, Bodakçı MN. Color Doppler sonographic evaluation of inter-relations between diameter, reflux and flow volume of testicular veins in varicocele. Eur J Radiol 2003;47:251–56.
• 4. Fretz PC, Sandlow JI. Varicocele: current concepts in pathophysiology, diagnosis, and treatment. Urol Clin North Am 2002;29:921-37.
• 5. Hargreave TB, Liakatas J. Physical examination for varicocele. Br J Urol 1991;67:328.
• 6. Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 1970;21:606–9.
• 7. Cornud F, Belin X, Amar E, Delafontaine D, Helenon O, Moreau JF. Varicocele: strategies in diagnosis and treatment. Eur Radiol 1999;9:536–45.
• 8. Gonda RL, Karo JJ, Forte RA, O’Donnell KT. Diagnosis of subclinical varicocele in infertility. Am J Roentgenol 1987;148:71–77.
• 9. 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.
• 10. Tarhan S, Gümüs B, Gündüz I, Ayyildiz V, Göktan C. Effect of varicocele on testicular artery blood flow in men-color Doppler investigation. Scand J Urol Nephrol 2003;37:38–42.
• 11. Unsal A, Turgut AT, Taşkin F, Koşar U, Karaman CZ. Resistance and pulsatility index increase in capsular branches of testicular artery: indicator of impaired testicular microcirculation in varicocele. J Clin Ultrasound 2007;35:191–95.
• 12. Zini A, Buckspan M, Berardinucci D, Jarvi K. The influence of clinical and subclinical varicocele on testicular volume. Fertil Steril 1997; 68:671–74.
• 13. Kervancioglu S, Sarica A, Mete A, Ozkur A, Bayram M. Varikoselin testis hacmi üzerine etkisi. Gaziantep Tip Dergisi 2008;1:11–18.
• 14. Pasqualotto FF, Lucon AM, De Goes PM, et al. Semen profile, testicular volume and hormonal levels in infertile patients with Varicoceles compared with fertile men with and without varicoceles. Fertil Steril 2005;83:74–77.
• 15. Cayan S, Kadioglu A, Orhan I, Kandirali E, Tefekli A, Tellaloglu S. The effect of microsurgical varicocelectomy on serum follicle stimulating hormone, testosterone and free testosterone levels in infertile men with varicocele. BJU Int 1999;84:1046-49.