The Role of Color Doppler Ultrasound in Prediction of the Outcome of Microsurgical Subinguinal Varicocelectomy Alayman H

Urology Department, Mink University Hospital, El-Minia, Egypt Email: alaymanh @hotrnail. corn
Objective: Over-diagnosis and under treatment of varicocele may be responsible for poor outcome of varicocelectomy. In this
study, we used Color Doppler ultrasound for accurate diagnosis and grading of varicocele and to predict the outcome of
microsurgical subinguinal varicocelectomy.
Materials and Methods: A total of 104 patients undergoing microsurgical subinguinal varicocelectomy for treatment of
infertility were included in this study. Patients were evaluated with routine history, physical examination, semen analysis,
hormonal assessment and scrotal ultrasound and Doppler. After varicocelectomy, improvement index, in sperm concentration, was
calculated by dividing the difference between the postoperative and preoperative sperm concentration by the preoperative
sperm concentration. Improvement Index greater than 0.5 is considered a good outcome. Statistical analysis was done to study
the correlation between microsurgical varicocelectomy outcome and testicular vein diameter at the inferior pole of the testis
and the degree of reflux measured by color Doppler ultrasound.
Results: Improvement index in sperm concentration, motility and morphology more than 0.5 was achieved in 58.8%, 27.3% and
17.6% of cases respectively. We found that patients with testicular vein diameter, at the inferior pole of the testis, more
than 2.5 have significantly higher improvement index in sperm concentration, motility and morphology than in patients with
testicular vein diameter less than 2.5mm (p=0.006, 0.016, 0.041 respectively). We also found that patients with clear reflux
detected by color Doppler ultrasound at the inferior pole of the testis have a significantly higher improvement index in sperm concentration, motility and morphology than patients with reflux detected only in the supratesticular venous
channels (p=0.013, 0.015 and 0.045 respectively).
Conclusion: Color Doppler ultrasound is a useful tool for accurate diagnosis and grading of varicocele and to predict the
outcome of varicocelectomy. We recommend doing varicocelectomy in cases of testicular vein diameter more than 2.5mm and in
cases of reflux detected at veins at the lower pole of the testis. Al-Hasam S Gynecology and Obstetrics Deparemnt, University of Schleswig-Holstein, Section of Andrology, Campus of Luebeck, Ratzeburger Allee 160, 23560 Luebeck, Germany Email: sf_alhasani@hotmail.com
Functions of seminal vesicle, prostate and bilateral testes can generally be determined by parameters of sperm analysis such
like concentration, motility, morphology, semen volume, and pH. Infertile men frequently have lower sperm parameters than
their fertile counterparts. However the results of sperm analyses among these groups are sometimes overlapping. As well
traditional spermiogram and classical morphological assessment even based on strict morphological criteria sometimes fail in
certain prediction of reproductive outcome of infertile men who undergone artificial reproductive techniques with their
partners. Thus new and more sensitive methods, especially for detecting sperm function and viability, were being needed by
many experts. Human sperm DNA is one of the most attractive targets for majority of experts during advances. Therefore
various clinicians assumed that sperm DNA might comprise many useful. clinical parameters and predictors for reproductive
outcome. Conversely to loose structure of chromatin (DNA and nuclear proteins) in somatic cells, chromatin is tightly
compacted due to unique associations between the DNA and sperm nuclear proteins.
Human Sperm Damage: Modern Andrology and DNA Trends o