OKTAY ÜÇER, Mehmet Fatih ZEREN, SERDAR TARHAN, Bilal GÜMÜŞ

Does varicocele affect testicular arterial blood flow?

Amaç: Normal sperm parametrelerine sahip sol varikolselli hastalar ile sa ğlıklı kontrol grubu aras ındaki testiküler kan akımı de ğerlerini karşıla ştırmaktır. Gereç ve Yöntem: Çalışmaya sol varikoselli 40 hasta ve 25 sa ğlıklı gönüllü dahil edildi. Tüm katılımc ıların her iki testislerindeki kan ak ımı renkli Doppler ultrason ile değ erlendirildi. Testiküler kan akımları testiküler, kapsüler ve intratestiküler arterlerde ölçldü. Hasta grubunda ayrıca semen parametreleri de de ğerlendirildi. Her iki gruptaki testiküler kan akım de ğ erleri istatistiksel olarak karşıla ştırıldı. Bulgular: Hasta ve kontrol grubunun ortalama ya şları sıras ı ile 24,92±4,34 ve 23,42±4,42 idi (p>0,05). Sol testiste sadece testiküler arterin rezistans indeksi hasta grubunda anlamlı olarak düşük bulundu (p=0,02). Sağ tetstiste ise testiküler arterin hem rezistans hem de pulsatil indeksleri hasta grubunda anlamlı olarak düşüktü (sırası ile p=0,01; p=0,01). Sonuç: Her iki testisteki kan ak ım parametrelerinin ço ğunlu ğunda fark ç ıkmamas ı hastaların normal semen parametrelerine sahip hastalar olmasından kaynaklanabilir. Anormal sperm parametrelerine sahip varikoselli hastalarda testiküler kan ak ımının de ğ erlendirildiği uzun takip süreli ileri çalış malar yapılmasını önermekteyiz .

Varikosel testiküler arteriyel kan akımını etkiliyormu?

Objective: To compare the changes of testicular blood supply in the control group and patient group with varicocele and normal sperm parameters. Material and Method: 40 patients with left varicocele and 25 healthy controls were enrolled in the study. All participants were performed color Doppler sonography to assess testicular blood flow of the both right and left testes. Blood flow parameters were measured in testicular, capsular and intratesticular arteries. Semen parameters were also assessed in the participants of the patient group. Testicular blood flow parameters were compared between the two groups. Results: Mean ages of the patients and controls were respectively, 24,92±4,34 and 23,42±4,42(p>0,05). In the left testes; only the resistive index values of testicular artery were significantly lower in the patients (p=0,02). In the right testes; the resistive and pulsatility index values of testicular artery were significantly lower in the patients (p=0,01; p=0,01). Conclusion: Most of testicular blood flow parameters in the both testes were similar. These may be the result of the normal semen parameters of the patients. We suggest that testicular blood flow in patients with varicocele and normal sperm parameters should be investigated by further studies with long term follow up.

PDF

___

1. 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.
2. Naughton CK, Nangia AK, Agarwal A. Pathophysiology of varicoceles in male infertility. Hum Reprod Update 2001; 7: 473-81.
3. Milone M, Musella M, Fernandez ME, et al. Varicocele repair in severe oligozoospermia: A case report of post-operative azoospermia. World J Clin Cases 2014; 2: 94-6.
4. Peluso G, Palmieri A, Cozza PP, et al. The study of spermatic DNA fragmentation and sperm motility in infertile subjects. Arch Ital Urol Androl 2013; 85: 8-13.
5. Balci A, Karazincir S, Gorur S, et al. Longterm effect of varicocele repair on intratesticular arterial resistance index. J Clin Ultrasound 2008; 36: 148-52.
6. Tarhan S, Ucer O, Sahin MO, et al. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow. J Androl 2011; 32: 33-9.
7. Tarhan S, Gümüs B, Gündüz I, et al. Effect of varicocele on testicular artery blood flow in men-color Doppler investigation. Scand J Urol Nephrol 2003; 37: 38-42.
8. Hassan A, Gad HM, Mostafa T. Radiologically assessed testicular changes in infertile males with varicocele. Andrologia 2011; 43: 307-11.
9. Hudson RW. The endocrinology of varicoceles. Fertil Steril 1988; 49: 199-208.
10. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction, 4th edn. Cambridge, UK: Cambridge University Press, 1999.
11. Schurich M, Aigner F, Frauscher F, et al. The role of ultrasound in assessment of male fertility. Eur J Obstet Gynecol Reprod Biol 2009; 144: 192-8.
12. Unsal A, Turgut AT, Ta şkin F, et al. Resistance and pulsatility index increase in capsular branches of testicular artery: indicator of impaired testicular microcirculation in varicocele? J Clin Ultrasound 2007; 35: 191-5.