Hydrodynamic relationship between color Doppler ultrasonography findings and the number of internal spermatic veins in varicoceles.
OBJECTIVE
The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy.


METHODS
In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist.


RESULTS
Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated.


CONCLUSIONS
Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.
Department of Urology, Gachon University Gil Hospital, Incheon, Korea.
Tae Beom
TB
Kim
Joo Hyun
JH
Chang
Sang Jin
SJ
Yoon
Soo Woong
SW
Kim
D000293:Adolescent; D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012661:Semen / Q000378:metabolism; D013733:Testicular Diseases / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014646:Varicocele / Q000000981:diagnostic imaging* / Q000473:pathology; D014680:Veins / Q000000981:diagnostic imaging*; D055815:Young Adult