Subklinik Varikosel Olgularında Semen Analizi ile Reflü Akımın Doppler Ultrason Bulguları Arasındaki İlişkinin Araştırılması
Amaç: Fizik muayene ile tespit edilemeyen subklinik varikosel olgularında renkli Doppler ultrasonografi (RDUS) ile reflü debisi, akım hızları ve akım sürelerinin ölçümü, RDUS bulgularının semen analizi ile ilişkisini araştırmak. Yöntemler: İnfertilite bakımından araştırılan ve klinik olarak varikoseli olmayan toplam 219 olguya renkli Doppler US incelemesi yapıldı. Ven çapları 2 mm’den büyük veya 1 sn ve daha uzun süreli reflü akımı bulunan 61 kişi subklinik varikosel kabul edilerek incelemeye dahil edildi. Bu olgularda RDUS incelemesi sırtüstü yatar pozisyonda uygulandı. Her iki tarafta pleksus pampiniformis venlerinde istirahatte ve Valsalva manevrası esnasında reflü debisi, akım hızı, akım süresi ölçüldü. Subklinik varikosel olgularında semen analizindeki anormallik ile RDUS incelemelerinde tespit edilen reflü debisi, akım hızı ve akım süreleri arasında ilişki varlığı araştırıldı. Bulgular: Subklinik varikosel olgularında ven çapları istirahat halinde ortalama 2.35 mm, valsalva ile 2.61 mm ölçüldü. Valsalva ile ortalama reflü debisi 13.56 mL/dk, akım süreleri 1.32 sn, akım hızları 5.6 cm/sn bulundu. Bu olguların 13 ünde semen analizinde anormallik mevcut idi (%21,3). Reflü süresi ile reflü akım hızları arasında anlamlı korelasyon bulunmuştur. Ancak reflü debisi, hızları ve süresi ile semen analizleri arasında belirgin bir ilişki tespit edilemedi. Sonuç: Subklinik varikosel olgularının tespit edilebilmesi için RDUS değerli bir tanı yöntemi olup ven çapı ve reflünün tespitinde oldukça başarıldır. Reflü debisi, akım hızı ve reflü süresi ile semen analizi arasında anlamlı ilişki bulunamamıştır. Ancak daha büyük bir grupla yapılacak çalışma daha faydalı bilgiler verebilir.
The Investigation of the Relationship Between Semen Analysis and Doppler Ultrasonografic Findings of Reflux Flow in Patients with Subclinical Varicocele
Objective: The aim of the present study was to the measurement of reflux flow volume, velocity and duration withcolor doppler ultrasonography (CDUS) in subclinical varicocele cases, and comparison of CDUS findings with semenanalysis.Method: 219 infertile men with no clinical overt varicocele are examined with CDUS. 61 people who have veindiameter bigger than 2 mm, or have 1 second or longer reflux flow were classified as subclinical varicocele. CDUSexamination is implemented in decubitus position. Reflux flow volume, velocity and duration of reflux in plexuspampiniformis veins were measured bilaterally during Valsalva maneuver.Results: In subclinical varicocele cases, mean vein diameters were measured mean 2.35 mm while resting, and 2.61mm during Valsalva maneuver. With Valsalva mean reflux flow volume was 13.56 mL/min, duration was 1.32 sec,flow velocity was 5.6 cm/sec. There were anomaly in semen analysis of 13 of these cases (21.3%). A significantcorrelation between reflux duration and reflux flow velocity are found. However, no significant relation betweenreflux flow volume, velocity and duration with semen analysis is detected.Conclusion: In subclinic varicocele cases, CDUS is a valuable diagonistic procedure that is quite successful on detectingthe vein diameter and reflux. No relation was found between reflux flow volume, velocity and duration with semenanalysis. However, a study commited with a larger group could give more useful information.
___
- 1. Spencer WG. Celsus de Medicina: with an English
translation. Cambridge: Harvard University Press,
1938.
- 2. Noske HD, Weidner W. Varicocele a historical
perspective. World J Urol. 1999; 17: 151–7.
- 3. Sakamoto H, Saito K, Shichizyo T, et al. Color Doppler
ultrasonography as a routine clinical examination in
male infertility. Int J Urol. 2006; 13: 1073–78.
- 4. Gat Y, Zukerman Z, Chakraborty J, Gornish M.
Varicocele, hypoxia and male infertility. Fluid
Mechanics analysis of the impaired testicular venous
drainage system. Hum Reprod. 2005; 20: 2614–19.
- 5. Trussell JC, Haas GP, Wojtowycz A, Landas S, Blank W.
High prevalence of bilateral varicoceles confirmed with
ultrasonography. Int Urol Nephrol. 2003; 35: 115–8.
- 6. World Health Organization. The influence of varicocele
on parameters of fertility in a large group of men
presenting to infertility clinics. Fertil Steril. 1992; 57:
1289–93.
- 7. Kroese ACJ, de Lange NM, Collins J, Evers JLH. Surgery
or embolization for varicoceles in subfertile men.
Cochrane Database of Systematic Reviews. 2012; 10:
CD000479.
- 8. Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing
the value of varicocelectomy as a treatment for male
subfertility with a new meta-analysis. Fertil Steril.
2007; 88: 639–48.
- 9. Abdel-Meguid T, Al-Sayyad A, Tayib A, Farsi HM. Does
varicocele repair improve male infertility? an evidencebased perspective from a randomized, controlled trial.
Eur Urol. 2011; 59: 455–61.
- 10. World Health Organization: Laboratory manual for
the examination and processing of human semen, 5th
ed. Geneva: WHO Press, 2010.
- 11. Trum JW, Gubler FM, Laan R, van der Veen F. The
value of palpation, varicoscreen contact thermography
and colour Doppler ultrasound in the diagnosis of
varicocele. Hum Reprod. 1996; 11: 1232–35.
- 12. EAU (2010) EAU Guidelines edition presented at the
25th EAU Annual Congress: EAU Guidelines Office,
Arnhem, The Netherlands.
- 13. Gorelick JI, Goldstein M. Loss of fertility in men with
varicocele. Fertil Steril. 1993; 59: 613-6.
- 14. Hoekstra T, Witt MA. The correlation of internal
spermatic vein palpability with ultrasonographic
diameter and reversal of venous flow. J Urol. 1995; 153:
82–4.
- 15. Cina A, Minnetti M, Pirronti T, et al. Sonographic
quantitative evaluation of scrotal veins in healthy
subjects: normative values and implications for the
diagnosis of varicocele. Eur Urol. 2006; 50: 345–50.
- 16. Orda R, Sayfan J, Manor H, Witz E, Sofer Y. Diagnosis
of varicocele and postoperative evaluation using
inguinal ultrasonography. Ann Surg. 1987; 206: 99–
101.
- 17. Schiff JD, Li PS, Goldstein M. Correlation of
ultrasoundmeasured venous size and reversal of flow
with Valsalva with improvement in semen-analysis
parameters after varicocelectomy. Fertil Steril. 2006;
86: 250–2.
- 18. Kocakoc E, Serhatlioglu S, Kiris A, et al. Color Doppler
sonographic evaluation of inter-relations between
diameter, reflux and flow volume of testicular veins in
varicocele. Eur J Radiol. 2003; 47: 251–6.
- 19. Wolverson MK, Houttuin E, Heiberg E, Sundaram M,
Gregory J. High-resolution real-time sonography of
scrotal varicocele. AJR Am J Roentgenol. 1983; 141:
775–9.
- 20. Caskurlu T, Tasci AI, Resim S, Sahinkanat T, Ekerbicer
H. Reliability of venous diameter in the diagnosis of
subclinical varicocele. Urol Int. 2003; 71: 83–6.
- 21. Hussein AF. The role of color Doppler ultrasound in
prediction of the outcome of microsurgical subinguinal
varicocelectomy. J Urol. 2006; 176: 2141–5.
- 22. Jarow JP, Ogle SR, Eskew LA. Seminal improvement
following repair of ultrasound detected subclinical
varicoceles. J Urol. 1996; 155: 1287–90.
- 23. Liguori G, Trombetta C, Garaffa G, et al. Color Doppler
ultrasound investigation of varicocele. World J Urol.
2004; 22: 378–81.
- 24. Arslan H, Sakarya ME, Atilla MK. Clinical value of
power Doppler sonography in the diagnosis of
varicocele. J Clin Ultrasound. 1998; 26: 229.
- 25. Gonda RL, Jr., Karo JJ, Forte RA, O’Donnell KT.
Diagnosis of subclinical varicocele in infertility. Am J
Roentgenol. 1987; 148: 71-5.
- 26. Chiou RK, Anderson JC, Wobig RK, et al. Color Doppler
ultrasound criteria to diagnose varicoceles: correlation
of a new scoring system with physical examination.
Urology. 1997; 50: 953-6.
- 27. Dubin L, Amelar RD. Varicocele size and results of
varicocelectomy in selected subfertile men with
varicocele. Fertil Steril. 1970; 21: 606-9.
- 28. Vivas-Acevedo G, Lozano JR, Camejo MI. Effect of
Varicocele Grade and Age on Seminal Parameters. Urol
Int. 2010; 85: 194-9.
- 29. Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of
microsurgical varicocelectomy is superior for men with
bilateral versus unilateral repair. J Urol. 2006; 176:
2602–5.
- 30. Richardson I, Nagler HM. Is bilateral varicocele more
detrimental to male fertility than unilateral varicocele?
Nat Clin Pract Urol. 2007; 4: 366–7.