Dissertation committee:
Χαράλαμπος Δεληβελιώτης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μιχαήλ Χρυσοφός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Βαρκαράκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αθανάσιος Παπατσώρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αθανάσιος Δελλής, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Αδαμάκης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ηρακλής Μητσογιάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
INTRODUCTION: Unlike the clinical form, subclinical varicocele is not an indication of treatment, whereas there are no reliable markers for the assessment of the severity or surveillance. In our present study, we evaluated and followed a population of men with subclinical varicocele and calculated statistical correlations between ultrasonographic and clinical characteristics.
MATERIALS AND METHODS: Our study was carried out at the Urological Clinic of General Hospital of Patras between 2017-2020. It included 80 men with subclinical varicocele. Men were divided into Group 1, patients with normospermia, and Group 2, patients with dyspermia (at least one disorder in the principal parameters of spermogram as per WHO: concentration, motility, and morphology). After 6 months the patients were clinically reviewed with new spermiogram and had an ultrasound repeated.
RESULTS: Forty-three and 37 men formed group 1 and group 2 (29 men with asthenospermia, 8 with oligo-asthenospermia), respectively. The presence of bilateral varicocele was associated with an increased relative risk for dyspermia (RR 2.43, 95% CI 1.45 to 3.89, p=0.006). Statistically significant difference was observed between groups 1 & 2 in terms of the parameters Total motile Sperm Count (TMSC), maximal vein diameters on the left, Body mass index, mean RI (Resistive Index), PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity) (p<0.05) but not in terms of total testicular volume, volume deferential, maximal diameters on the right, age, and RI ratio between left and right (p>0.05).
In the sub-group of men with normospermia and unilateral varicocele (n=33), the presence of persisting reflux in Valsava was associated with a larger maximum varicose vein diameter (p<0.05). In the sub-group of men with normospermia and bilateral varicocele (n=10), the maximum diameters of the vessels differed significantly between the different degrees of reflux (declining and not declining during the Valsava) left and right, while the left varicoceles were greater than the right ones, regardless of the type of the reflux (p<0.05). In men with normospermia, no statistically significant correlations were found between clinical and ultrasound parameters.
In the sub-group of dyspermic men with unilateral varicocele (n=14), a statistically significant correlation of total testicular volume, mean RI value RI ratio and volume differential with sperm concentration; between the testicular volume difference and TMSC; total testicular volume with testosterone (p<0.05). In the sub-group of men with dyspermia and bilateral varicocele (n=23) venous size was not significantly different between sides. A statistically significant correlation was found between the mean RI value with sperm concentration; the mean RI value and serum testosterone; the total testicular volume with sperm concentration, motility, testosterone, TMSC and FSH (p<0.05).
After 6 months, a statistically significant difference in TMSC was found among all participants (p<0.05). Men with normospermia showed no statistically significant changes in the TMSC number (p>0.05). In contrast, the sub-groups of dyspermia had statistically significant differences (dyspermic with unilateral varicocele, -2.7 +/- 2.33, p=0.002 / dyspermic with bilateral varicocele, -0.93 +/- 1.67, p=0.014). The RI index at diagnosis showed a statistically significant, positive correlation with the deterioration of TMSC in men with dyspermia.
CONCLUSIONS: Bilateral varicocele seems to be associated with an increased likelihood of dyspermia versus unilateral localization. Also, dyspermia appears to be accompanied by affected hemodynamic parameters and especially an increased mean RI value, which may act as a preliminary severity indicator; in men with dyspermia, RI is negatively associated with sperm concentration and motility. The 6-month period is followed by a significant decrease in the total number of progressively motile spermatozoa in all men with subclinical varicocele. However, the decrease is statistically but also clinically more important in men found with dyspermia during the initial check. Finally, the mean RI index at diagnosis shows a significant positive correlation with the change in TMSC after 6 months.
