Spermatic Vein Reflux Research Articles

Doppler flow studies, venography and thermography in the evaluation of varicoceles of fertile and subfertile men.

The varicoceles of 39 men of proven fertility and 57 husbands of infertile marriages were assessed by the Doppler technique and classified according to venous activity. Retrograde left renal venography in 17 subjects showed that Doppler grading was unable to distinguish between 7 patients with competent internal spermatic veins and 10 with internal spermatic vein reflux. Patients whose varicoceles were associated with internal spermatic vein reflux had a significant reduction in sperm density and these may be implicated as a cause of male infertility. The remaining varicoceles were probably the result of incompetence of other venous tributaries of the spermatic cord and were associated with higher sperm densities. The Doppler was able to identify accurately those varicoceles with significant elevation of scrotal temperature as determined by computer assisted infra-red scrotal thermography. The sperm densities of these patients were similar to the values found in patients with normal scrotal temperatures. The varicoceles of infertile men were found to have a greater incidence of spontaneous venous activity than the varicoceles of fertile men and this suggests that any reduction of fertility caused by elevation of scrotal temperature may be via an effect other than a reduction in sperm density.

The Doppler assessment of varicoceles and internal spermatic vein reflux in infertile men.

The Doppler technique has been used to evaluate venous reflux in the spermatic cord. Valsalva-induced reflux occurred on the left side in 83% and on the right side in 59% of 118 patients without clinical varicoceles and there was no difference in incidence between fertile and infertile men. The significance of Valsalva-induced reflux should be questioned. Greater importance should be attributed to the spontaneous venous reflux that occurred during quiet respiration in the majority of patients with varicoceles. Seven velocity waveform patterns are described and these are thought to represent increasing degrees of internal spermatic vein reflux and provide a basis on which it is possible to grade varicoceles. The Doppler grades correlated with the size of the varicocele, and with the internal spermatic vein diameter and testosterone concentrations.