Long-Term Effect of Microsurgical Inguinal Varicocelectomy on Testicular Blood Flow

Abstract

We aimed to investigate the long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow using color Doppler sonography (CDS) in this observational study. A total of 30 patients clinically diagnosed with left varicocele who underwent a microsurgical inguinal varicocelectomy were examined 3 times with CDS for testicular blood flow parameters, first before, then 3 months after, and finally 6 months after the operation. CDS values of testicular blood flow (peak systolic velocity, end diastolic velocity, resistive index, and pulsatility index) were measured from testicular, capsular, and intratesticular arteries. We also evaluated preoperative and postoperative semen parameters. The mean values of blood flow velocities in the left testicular artery (peak systolic and end diastolic) increased and resistance indices (resistive and pulsatility) in the left capsular and intratesticular arteries decreased significantly after surgery (P , .05).No significant difference was detected between the preoperative and postoperative blood flow parameters in the right testicular, capsular, or intratesticular arteries (P , .05). In the semen analysis run 3 months after the operations, statistically significant increases were found in sperm concentration (P , .001), morphology percentage (P , .001), and total motile sperm concentration (P 5 .009). The increase in blood flow velocity in the testicular artery and the decrease in resistive and pulsatility indices in the capsular and intratesticular branches of the artery may be strong indicators of an increase in testicular arterial blood flow into the testicular tissue. Our data show that a significant improvement occurs in testicular blood supply and sperm parameters after microsurgical inguinal varicocelectomy.

Color Doppler ultrasound characteristics after subinguinal microscopic varicocelectomy

“…The authors criticized themselves, as very early postoperative evaluation may not provide accurate information about testicular hemodynamics. Similar to Tarhan et al [12], we also think that late assessment of these parameters would provide more information about the microhemodynamics of the testes and the success of the operation because it may take several months for the edema and inflammation in the operative field to recover. We think that a greater number of significant correlations between the pre-operative and second postoperative values proves this hypothesis.…”

“…The PSV and EDV were increased in the left TA, and the RI and PI of the left CA and ITA were decreased, but the authors did not observe any change in these parameters in the right arteries. They also found a significant correlation between the semen analysis and the PSV, RI, and PI of the left CA [12]. With a significant correlation between improved testicular hemodynamics and semen parameters, the authors suggested that testicular blood flow parameters could be used in the postoperative follow-up of patients with varicocele.…”

“…Tarhan et al investigated the long-term effects of inguinal MVS on blood flow and semen parameters [12]. The PSV and EDV were increased in the left TA, and the RI and PI of the left CA and ITA were decreased, but the authors did not observe any change in these parameters in the right arteries.…”

“…The TA divides into two branches; the capsular artery (CA) that continues on the surface of the testis and the intratesticular artery (ITA) that goes deep into the parenchyma of the testis [10]. Scrotal color Doppler ultrasound (CDUS) has been established as an effective and accurate diagnostic tool for examining the macro and microvascularity of the testes, in which arterial flow velocities (peak systolic velocity [PSV] and end-diastolic velocity [EDV]) and resistance indices (e.g., resistive index [RI] and pulsatility index [PI]) can be easily measured [10][11][12].…”

Children and adults varicocele: diagnostic issues and therapeutical strategies

“…Studies involving RI measurements in patients with abnormal semen analysis have shown increased RI values compared to the threshold value of 0.60, and color-Doppler studies performed in azoospermic patients have allegedly shown that the quality and quantity of the ejaculate depend on the degree of blood circulation in the testicles. Reduced arterial perfusion was observed in patients with varicocele and impaired spermatogenesis, probably as a result of a metabolic deficiency affecting the microcirculation [37].…”