The Comparison of Resistance Index of Testicular Artery Using Color Doppler Ultrasound in Infertile Men Undergoing Varicocelectomy

Abstract

Background: Varicocele is one of the leading causes of infertility in men. Resistance index (RI) in testis is a parameter indicating parenchymal perfusion and microvascular functions. Increased RI in the testis of patients with varicocele might be a sign of impairments in microvascularization and a significant decrease in testicular perfusion. In the present study, RI in capsular and intraparenchymal testicular arteries was evaluated in patients with varicocele who underwent varicocelectomy.
 Methods: This prospective cohort study was performed in 2019-2020 in Guilan, Iran. Sixty-six patients were included. Semen analysis was also done before surgeries. Patients with at least one disorder in semen analysis entered the study. RI in testicular arteries was measured by an experienced radiologist before surgeries. Six months after varicocelectomy, all patients underwent the same semen analysis and ultrasound imaging. Data were analyzed using SPSS software. The tests for analysis included McNemar Test and Wilcoxon and p<0.005 was considered as the significance level.
 Results: According to the results, 42 patients (63.6%) had positive changes in sperm analysis after surgeries. Sperm analysis showed a significant increase in number, concentration, morphology, and motility of sperm after surgeries (p<0.001). Further measurements of capsular and intratesticular RI in all patients also indicated a significant decrease (p<0.001).
 Conclusion: Increased RI might be associated with impaired microperfusion in testis followed by impairments in semen. Moreover, mean capsular and intratesticular RI in patients decreased after surgeries and this decrease was significantly more in patients who had improvement in their semen parameters.

Dynamic contrast-enhanced MRI in the assessment of testicular perfusion in infertile men with clinical varicocele

“…In addition, an increase in wash-in rate was also observed in the controls without varicocele and oligospermia, showing the efficacy of this specific DCE-MRI parameter to detect minor changes of testicular microcirculation in men with defective spermatogenesis (18). CDUS also assessed the hemodynamic changes and the testicular vascularization in testes with clinical varicocele (11)(12)(13)(14)(15)(16). A significant decrease in testicular arterial blood flow was noted, manifested as an increase in peak systolic velocity and resistive index in testes with clinical varicocele (11)(12)(13)(14)(15)(16).…”

“…The study of alterations of testicular perfusion in infertile men with varicocele represents a topic of active research (1,11–18). Similar to our results, CEUS in a study of 90 men with left varicocele, found higher values of wash-in rate in patients with varicocele associated with either normozoospermia or oligospermia (18).…”

“…CDUS also assessed the hemodynamic changes and the testicular vascularization in testes with clinical varicocele (11)(12)(13)(14)(15)(16). A significant decrease in testicular arterial blood flow was noted, manifested as an increase in peak systolic velocity and resistive index in testes with clinical varicocele (11)(12)(13)(14)(15)(16). The peak systolic velocity represents an arterial blood flow parameter, corresponding to the early, tall peak in the spectral window.…”

“…Imaging, including ultrasound (US) and magnetic resonance imaging (MRI), has improved the ability of non-invasive assessment of the harmful effects of spermatogenesis in testes with varicocele, although its routine clinical use is still not justified (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Reduced testicular arterial perfusion, assessed by color Doppler US (CDUS) and contrast-enhanced US (CEUS) and a decrease in elastography values have been reported in testes with varicocele and impaired spermatogenesis (11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…Imaging, including ultrasound (US) and magnetic resonance imaging (MRI), has improved the ability of non-invasive assessment of the harmful effects of spermatogenesis in testes with varicocele, although its routine clinical use is still not justified (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Reduced testicular arterial perfusion, assessed by color Doppler US (CDUS) and contrast-enhanced US (CEUS) and a decrease in elastography values have been reported in testes with varicocele and impaired spermatogenesis (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). A decrease in apparent diffusion coefficient and fractional anisotropy values and alterations in the biochemical profile of testes in infertile men with clinical varicocele have also been noted, probably correlating with the defects in spermatogenesis (21)(22)(23)(24)(25)(26).…”