Correlation between sonographic and clinically palpable varicoceles with their effects on semen quality and testicular size

ABSTRACT

To evaluate the effects of different grades of palpable varicoceles, on the testicular volume and semen quality in men with infertility. This prospective study included 90 infertile patients presenting to Urology Department El-Sahel Teaching Hospital from May 2006 to May 2009. Their ages ranged between 22-35 years with a mean of 25.7 +/- 3.15 years. After excluding female factor and taking informed consent, evaluation started and included complete history, clinical and sonographic examination, and semen analysis. Scrotal colour Doppler ultrasound using 6 - 12 MHz transducer, was done to detect veins calibers, testicular dimensions on the ipsilateral and contralateral sides of varicocele, presence or absence of venous reflux and its degree. Postoperatively, scrotal ultrasound and semen analysis were done, 6 - 9 months after varicocelectomy. There were 42 [46.6%], 30 [33.3%] and 18 [20%] patients with veins calibers 6 - 9 mm, 5 - 6 mm and 4mm in grades III, II, I varicocele respectively. Patients with grades III and II varicoceles, had a significant reduction of testicular volume on the affected side in addition to impaired semen quality as regards sperm motility and concentration. Patients with grade I varicocele showed no significant change of testicular volume in addition to normal semen analysis. Varicocelectomy improved sperm motility and concentration in grades Ill, II varicocele patients. Venous reflux was present in all patients with grades III and II varicocele but in none of grade I varicocele patients. Scrotal colour Doppler Ultrasound is highly valuable in detecting varicoceles, testicular volumes, venous reflux and determining its degree. Varicocele exerts a deleterious effect on the ipsilateral testicular volume, sperm motility and concentration so careful evaluation and early surgical intervention is recommended in grades III and II varicocele patients to improve sperm motility and concentration. Varicocelectomy improved sperm motility and concentration in grades III, II varicocele patients but the reduction of the ipsilateral testicular volume [caused by varicocele], did not significantly change 6 - 9 months postoperatively