Testicular Arterial Perfusion in Varicocele: The Role of Rapid Sequence Scintigraphy with Technetium in Varicocele Evaluation

Abstract

Rapid sequence scintigraphy was used to study testicular arterial perfusion and venous stasis in 53 patients with varicocele-associated infertility, 17 with idiopathic testicular failure and 9 treated for varicocele. Arterial blood supply to the diseased testicle was decreased in 63 per cent of the patients with subclinical or low grade varicocele compared to 18 per cent with idiopathic testicular failure. In the majority of cases the disturbance of perfusion disappeared immediately after interruption of retrograde blood flow in the internal spermatic vein by transcatheter embolization, whereas persistently impaired perfusion was found in a few cases with no improvement of semen quality after treatment. Venous stasis was found in only 18 per cent of the patients with low grade varicocele compared to 88 per cent with large varicoceles. It is suggested that impaired arterial blood supply rather than venous stasis is the pathogenic factor in epididymo-testicular dysfunction associated with low grade varicocele.

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

“…Some researchers have hypothesized that impaired venous drainage causes an increase in venous stasis and a decrease in arterial blood flow, thus inducing hypoxia and deficiency in testicular microcirculation (Balci et al, 2008). Also, it is thought that this hypoxia could be responsible for defective energy metabolism at mitochondrial levels, causing dysfunction of both Leydig and germinal cells (Comhaire et al, 1983; Chakraborty et al, 1985; Unsal et al, 2007).…”

Clinical study of varicocele by sequential scrotal scintigraphy: Klinische Analyse mit sequentieller Skrotalszintigraphie der Varikozele

“…The time-activity curves were classified into four patterns, with reference to Comhaire's classification (Comhaire et al, 1983) as follows: Type 1: bilateral timeactivity curves increased gradually and symmetrically; Type 2: time-activity curves rose gradually and to a higher level on the left than on the right; Type 3: radioactivity was lower on the left than on the right during the early phase of the time-activity curves. The time-activity curves were classified into four patterns, with reference to Comhaire's classification (Comhaire et al, 1983) as follows: Type 1: bilateral timeactivity curves increased gradually and symmetrically; Type 2: time-activity curves rose gradually and to a higher level on the left than on the right; Type 3: radioactivity was lower on the left than on the right during the early phase of the time-activity curves.…”

“…When time-activity curves were evaluated, the early phase was plotted by elongating the time scale. The time-activity curves were classified into four patterns, with reference to Comhaire's classification (Comhaire et al, 1983) as follows: Type 1: bilateral timeactivity curves increased gradually and symmetrically; Type 2: time-activity curves rose gradually and to a higher level on the left than on the right; Type 3: radioactivity was lower on the left than on the right during the early phase of the time-activity curves. Thereafter the radioactivity increased grad-ually to a higher level on the left than on the right; Type 4: radioactivity on the left side accumulated quickly in the early phase and maintained a higher level than on the right side.…”

Male Infertility

“…The increased hydrostatic pressure in the intrascrotal veins enhances the physiological countercurrent exchange from these veins to the testicular artery that is coiled and surrounded within the venous plexus. The increased norepinephrine concentration causes constriction of the intratesticular arterioles (Chakraborty et al 1985), decreasing arterial perfusion as evidenced by isotope studies (Comhaire et al 1983). Long-lasting exposure to a high concentration of catecholamines and vasoconstriction results in endothelial hyperplasia of the intratesticular arterioles, rendering the perfusion deficit irreversible in spite of treatment interrupting reflux.…”