Changes in testicular arterial hemodynamic, gonadotropin levels, and semen parameters among varicocele patients randomized to varicocelectomy or observed in Tamale, Ghana

Abstract

Objective: A randomized trial to compared testicular blood flow parameters, gonadal hormones, and semen characteristics among three groups; surgery group (n = 127); observed group (n = 114); and healthy controls (n = 33).

Methods: The blood flow parameter selected was resistive index (RI) measured using color Doppler ultrasonography. Serum total testosterone, FSH, LH were measured, and semen analysis performed at baseline and repeated 12 months of follow-up. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05.

Results: In the observed group, increased +0.0060 in the right (R_RI) and in the left (L_RI) +0.0026 capsular arteries from baseline measurement to 12 months follow-up. Surgery group, reduced -0.079 in the right (R_RI) and -0.0731 in the left (L_RI) capsular arteries (p < 0.0001). At 12 months, the changes for both left and right RIcap in the surgery group did not reach the values of the controls. In the surgery group, L_RIcap (r = -0.63; p < 0.0001) and R_RIcap (r = -0.49; p = 0.004) correlated with total testosterone, FSH (r = 0.57; p = 0.001 for left; r = 0.52; p = 0.002 for right), and LH (r = 0.61; p = 0.0002 for left; r = 0.41; p = 0.020 for right). Furthermore, L_RIcap correlated with changes in sperm count (r = -0.46; p = 0.008) and sperm concentration (r = -0.35; p = 0.011) in the surgery group.

Conclusion: Microsurgical sub-inguinal varicocelectomy improves blood supply to the testicular tissues evidenced by reduced resistive index in the surgery group. Resistive index in the left capsular artery can be used to evaluate the success of surgery because it correlates with total testosterone, FSH, LH, and semen quality.

Keywords: Varicocele; color Doppler ultrasound; fertility; gonadotropins; microsurgical sub-inguinal varicocelectomy; resistive index; semen analysis.