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. 2015 Dec;36(12):1439-45.
doi: 10.15537/smj.2015.12.12755.

Preoperative duplex ultrasound parameters predicting male fertility after successful varicocelectomy

Fahad M Alshehri  1 , Mahboob H Akbar, Adel K Altwairgi, Omar J AlThaqufi
Affiliations

Preoperative duplex ultrasound parameters predicting male fertility after successful varicocelectomy

Fahad M Alshehri et al. Saudi Med J. 2015 Dec.

Abstract

Objectives: To assess duplex ultrasound (DUS) parameters, and predicti the outcome of varicocele ligation in male infertility.

Methods: This retrospective and follow up study was conducted at Dr. Sulaiman Al Habib Hospital, AlQassim, Saudi Arabia between January 2011 and December 2012. Eighty-two patients were selected, who presented with clinical/subclinical varicocele and male infertility. All these patients had DUS of the scrotum and underwent for low ligation varicocelectomy. These patients were followed for a period of 12-24 months after surgery for the occurrence of paternity. We reviewed pre-operative scrotal DUS of these 82 patients for the testicular size and volume, pampiniform veins caliber and duration of reflux in the dilated veins at rest, and after valsalva maneuver. These DUS parameters were correlated with the postoperative paternity rate.

Results: Postoperative paternity was achieved in 18 patients (31.6%) with normal-sized testes, and in 3 patients (12%) with small size testes. The positive paternity rate was higher (38.5%) in patients with clinically detected varicocele, compared with only 16.7% of patients with subclinical varicocele (detected by ultrasound only). In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (70.6%), with shunt-type varicocele (71.4%), and patients with a permanent grade of venous reflux (62.5%).

Conclusion: Selection of patients for the successful paternity after varicocele repair depends mainly on DUS parameters, which includes normal size testicles with shunt type of bilateral varicocele and continuous reflux.

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Figures

Figure 1
Figure 1
Color Doppler ultrasound of the scrotum showing dilated left pampiniform venous plexus with augmentation after Valsalva maneuver.
Figure 2
Figure 2
Color Doppler ultrasound in 2 different patients showing types of varicocele with spectral analysis. A) Stop type varicocele showing retrograde flow only. B) Shunt type varicocele showing retrograde and orthograde flow.
Figure 3
Figure 3
Relationship between testicular volume and positive post-operative paternity rate. Group 1 patients have normal testicular volume (>15 cm3). Group 2 patients have subnormal testicular volume (<15 cm3)
Figure 4
Figure 4
Relationship between clinical and subclinical varicocele and postoperative paternity rate in group 1 patients.
Figure 5
Figure 5
Relationship between site of varicocele and post-operative positive paternity rate in group 1 patients.
Figure 6
Figure 6
Relationship between site of varicocele and post-operative positive paternity rate in group 1 patients.
Figure 7
Figure 7
Relationship between site of varicocele and post-operative positive paternity rate in group 1 patients.
Figure 8
Figure 8
Relationship between site of varicocele and post-operative positive paternity rate in group 1 patients.
See this image and copyright information in PMC

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