The Role of Color Doppler Ultrasound in Prediction of the Outcome of Microsurgical Subinguinal Varicocelectomy

Abstract

Overdiagnosis and undertreatment of varicocele may be responsible for the poor outcome of varicocelectomy. In this study we used color Doppler ultrasound for accurate diagnosis and grading of varicocele, and for predicting the outcome of microsurgical subinguinal varicocelectomy. A total of 104 patients undergoing microsurgical subinguinal varicocelectomy for treatment of infertility were included in this study. Patients were evaluated with routine history, physical examination, semen analysis, hormonal assessment and scrotal ultrasound, and Doppler. After varicocelectomy improvement index in sperm concentration was calculated by dividing the difference between the postoperative and preoperative sperm concentration by the preoperative sperm concentration. Improvement index greater than 0.5 is considered a good outcome. Statistical analysis was done to study the correlation between microsurgical varicocelectomy outcome and testicular vein diameter at the inferior pole of the testis, and the degree of reflux measured by color Doppler ultrasound. Improvement index in sperm concentration, motility and morphology more than 0.5 was achieved in 58.8%, 27.3% and 17.6% of cases, respectively. We found that patients with a testicular vein diameter at the inferior pole of the testis of more than 2.5 mm have a significantly higher improvement index in sperm concentration, motility and morphology than patients with a testicular vein diameter less than 2.5 mm (p = 0.006, 0.016 and 0.041, respectively). We also found that patients with clear reflux detected by color Doppler ultrasound at the inferior pole of the testis have a significantly higher improvement index in sperm concentration, motility and morphology than patients with reflux detected only in the supratesticular venous channels (p = 0.013, 0.015 and 0.045, respectively). Color Doppler ultrasound is a useful tool for accurate diagnosis and grading of varicocele, and for predicting the outcome of varicocelectomy. We recommend varicocelectomy in cases of testicular vein diameter greater than 2.5 mm and in cases of reflux detected at the veins at the lower pole of the testis.