INTRODUCTION: The aims of the study were to: (1) evaluate the use of color Doppler ultrasound to diagnose and grade varicocele, and (2) identify the ultrasonographic patient selection criteria for microsurgical subinguinal varicocelectomy that would result in the best seminal improvement.
METHODS: Participants were 94 infertile patients undergoing microsurgical subinguinal varicocelectomy. All patients were evaluated with a case history, physical examination, semen analysis, hormonal assay, and color Doppler scrotal ultrasound. Postoperative improvement indexes in sperm concentration, sperm motility and normal sperm morphology were calculated. Improvement index > 0.5 was considered a good outcome. Statistical analysis was done to show the relationship between microsurgical varicocelectomy outcome and testicular vein diameter at the lower testicular pole and the degree of reflux measured by color Doppler ultrasound.
RESULTS: Seminal improvement indexes > 0.5 were found for sperm concentration, motility, and morphology in 61.3%, 29.9% and 19.3% of cases, respectively. Patients with testicular vein diameter ≥ 2.5 mm at the lower pole of the testis had a significantly higher seminal improvement index in sperm concentration, motility, and morphology than those with a testicular vein diameter < 2.5 mm (P = .001, .001, .003, respectively). Patients with reflux detected by color Doppler ultrasound at the lower pole of the testis had a significantly higher seminal improvement index in sperm concentration, motility, and morphology than patients with reflux only in the supratesticular venous channels (P = .02, .013, .042, respectively).
CONCLUSION: Color Doppler ultrasound is an important method for accurate diagnosis and grading of varicocele and for prediction of the outcome of varicocelectomy. Microsurgical subinguinal varicocelectomy is recommended for patients with testicular vein diameter ≥ 2.5 mm, regardless of the grade of reflux at the inferior pole of the testis.
KEYWORDS: Color Doppler ultrasound; Varicocele; Microsurgical varicocelectomy; Seminal improvement.
CORRESPONDENCE: Hashem Hafez, M.D., Department of Urology, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia 41115, Egypt ()
CITATION: UroToday Int J 2009 Aug;2(4). doi:10.3834/uij.1944-5784.2009.08.04.