Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele

Abstract

Varicocele is characterized by an abnormal dilatation and retrograde blood flow in the spermatic veins. Varicocele is the leading correctable cause of male infertility. Although it is highly prevalent in infertile men, it is also observed in individuals with normal fertility. Determining which men are negatively affected by varicocele would enable clinicians to better select those men who will benefit from treatment. To assess the functional status of the testes in men with varicocele, color Doppler sonographic parameters were evaluated. Testicular arterial blood flow was significantly reduced in men with varicocele, reflecting an impairment of spermatogenesis. An improvement in the testicular blood supply was found after varicocelectomy on spectral Doppler analysis. Testicular contrast harmonic imaging and elastography might improve our knowledge about the influence of varicocele on intratesticular microcirculation and tissue stiffness, respectively, providing possible information on the early damage of testicular structure by varicocele. Magnetic resonance imaging (MRI), with measurement of apparent diffusion coefficient has been used to assess the degree of testicular dysfunction and to evaluate the effectiveness of varicocele repair. Large prospective studies are needed to validate the possible role of functional sonography and MRI in the assessment of early defects of spermatogenesis in testes with varicocele.

Keywords: Diagnostic imaging; Doppler ultrasound imaging; Functional; Magnetic resonance imaging; Spermatogenesis; Ultrasonography; Varicocele.

Figure 1

A 24-year-old man with bilateral varicocele. A: Gray-scale sonographic images, longitudinal sections at the supratesticular region of the left hemiscrotum at rest and during the Valsalva maneuver. The maximal diameter of the left spermatic veins is 2.5 mm at rest and 3.5 mm during the Valsalva maneuver; B: Color Doppler sonographic images, longitudinal sections same level show blood flow reversal after Valsalva maneuver; C: Gray-scale sonographic images, longitudinal sections at the right supratesticular region. The maximal diameter of the right spermatic veins is 2.3 mm at rest and 2.8 mm during the Valsalva maneuver; D: Color Doppler sonographic images, longitudinal sections show flow reversal with Valsalva maneuver.

Figure 2

A 36-year-old man with left varicocele. Color Doppler sonographic images, longitudinal sections at the level of the upper (A) and lower pole (B) of the left testis depict blow flow reversal seen during the Valsalva maneuver.