[Echo-color doppler in the topographic study of varicocele].
The echo color doppler allows an easy topographical distinction of the spermatic reflux (in front of the deferens) from cremasteric one (back to the deferens). This distinction consents a rational surgical choice, the selective interruption of the refluent vein and a less morbidity due to the surgical intervention. We evaluated 20 infertile patients (mean age 23 years) with echo color doppler testicular vessels (B & K 7.5 Mhz transducer). Seven varicoceles were clinically evident, 13 varicoceles were subclinic. After locating the deferens, we evaluated the venous reflux in the spermatic and cremasteric veins. The evaluation has been performed at rest and during Valsava maneuver. We used, in the correction of the anterior (spermatic) reflux, a retroperitoneal surgical access, while in the back (cremasteric) reflux isolated or combined, we performed middle or under inguinal access. The mean follow up has been of 4 months. In all cases the veins with reflux have been easily characterized. In 16 patients (80%) the spermatic vein was concerned; in an isolated case (5%) the reflux concerned only the cremasteric vein, in 3 patients (15%), with clinical varicocele, the reflux was present in both the veins (Coolsaet III type). In the 16 spermatic varicoceles, treated with retroperitoneal access (Palomo), the echo color doppler check demonstrated the absence of venous reflux. In the 4 varicoceles regarding the isolated or associate cremasteric vein treated with middle or under inguinal access, the existence of extra funicular varix was highlighted and after surgery the echo color doppler check was negative. In our few cases the echo color doppler diagnosis demonstrated a total correspondence with the surgical finds and with the doppler follow up. This diagnostic approach allows to reserve the retroperitoneal surgery to the spermatic pure reflux avoiding the false relapses due to the persistence of an undiagnosed cremasteric reflux. The middle or under inguinal approaches, generally loaded from a greatest morbidity, could be only employed in presence of an isolated or combined cremasteric reflux.
Callea
A
A
Divisione di Urologia, Policlinico, Bari.
Berardi
B
B
Dilorenzo
V
V
Salerno
G
G
Jacobellis
U
U
D000328:Adult; D006801:Humans; D007248:Infertility, Male / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D018615:Ultrasonography, Doppler, Color; D014646:Varicocele / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery