Colour Doppler Sonography of the Ovarian Vein: Recognition and Associated Lesions.

AIM: The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography for ovarian veins. The clinical incidence of ovarian venous lesions is relatively low and often overlooked. The ovarian veins are located deep in the pelvis, and they are relatively elongated, which could make medical imaging more difficult. Therefore, there is limited literature on the diagnosis of ovarian venous disease. The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography towards ovarian vein. METHODS: A total of 37 consecutive patients with clinically suspected ovarian venous disorders were included. All the patients underwent colour Doppler sonography. CTV was performed in 31 patients, while retrograde phlebography was performed in 6 patients. CT/phlebography was the established diagnostic criterion for ovarian vein disorders. The SPSS 22.0 program was used for statistical analysis. Sensitivity, specificity, and positive and negative predictive values for colour Doppler sonography were calculated. k-test was used to evaluate consistency between colour Doppler sonography and CT/phlebography. RESULTS: In the 37 patients,18 cases were positive for ovarian vein disorders and 19 cases were negative, as assessed with colour Doppler sonography. The associated lesions included ovarian vein thrombosis (7 cases), ovarian varicocele (3 cases), and ovarian venous leiomyoma (8 cases). The calculated values of sensitivity, specificity, and positive and negative predictive value were 94.4%, 94.7%, 94.4%, and 94.7%, respectively. The overall accuracy rate was 94.9%. The k level of the degree of agreement between CT/phlebography and colour Doppler sonography was 0.892. CONCLUSION: Colour doppler sonography can provide sufficient imaging information. In clinical ultrasonography, attention should be paid to recognizing and detecting ovarian venous lesions.

A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting.

INTRODUCTION: Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy. METHODS: Retrospective cost-outcome study of patients treated by embolisation between January 2018 and 2023. A bottom-up approach was used to calculate procedure costs whereas a top-down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation. RESULTS: Costing data from 18 patients were included, of median age 33.5 years (range 26-60) and median varicocoele grade 2.5 (range 1-3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non-procedural, ward and peri-procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691-7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207). CONCLUSION: Total varicocoele embolisation cost and the cost per-pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low-cost pinhole procedure.

FDG Uptake Caused by Right Varicocele.

ABSTRACT: A 67-year-old man underwent 18 F-FDG PET/CT for lung cancer staging. Interestingly, the PET scan revealed strip-shaped FDG uptake in the right inguinal contoured area, which was later confirmed as a right varicocele through ultrasound imaging.

Assessing safety and efficacy of microscopic and laparoscopic varicocoelectomy for varicocoele treatment: A comparative cohort study.

BACKGROUND: Surgical is appropriate for 35-40% of varicocoele-induced infertility. This comparative observational study presents a comparative assessment of microscopic or laparoscopic varicocoelectomy (grade II varicocoele; n = 132 cases). METHODS: Sperm count, density, total motility, and forward motility rate (preoperative and postoperative 6 months), operation duration, pain at 1 month, testicular atrophy (by scrotal ultrasound at 3 months), recurrence (angiography at 6 months), and scrotal edema (at 12 months) were measured. RESULTS: The preoperative semen parameters were comparable between groups (P > 0.05), as were certain postoperative results (total sperm count [median 162 (range 100-242) compared with median 182 (range 84-253)]; sperm density [median 47 (range 38-83) compared with median 42 (range 27-88)]; forward motility (37.18 ± 4.14 compared with 34.13 ± 7.79); P > 0.05). However, sperm motility was higher in the microscope group (52.79 ± 8.21 compared with 46.64 ± 10.04; t = 2.304, P = 0.040). Within the microscope group, postoperative sperm density [median 47 (range 38-83)], total sperm motility (53.79 ± 8.25), and forward motility sperm rate (37.19 ± 4.14) demonstrated significant improvements compared with preoperative values (Z = -2.679, P = 0.005; t = -4.548, P < 0.001; t = -5.029, P < 0.001). In contrast, the postoperative forward motility sperm rate (34.13 ± 7.78) displayed substantial improvements compared with preoperative values (27.74 ± 14.42) within the laparoscopic group (t = -3.895, P = 0.001). Testicular atrophy occurred in neither group. CONCLUSIONS: Microscopic varicocoelectomy may be safer and more effective.

Testicular catch-up growth in the non-operative management of the adolescent varicocele.

INTRODUCTION: Adolescent varicocele is a common urologic condition with a spectrum of outcomes, leading to variations in management. Testicular hypotrophy is a common indication for surgery Routine monitoring may be an appropriate form of management for many adolescents with testicular hypotrophy, as studies have shown that a large proportion of these patients may experience catch-up growth of the ipsilateral testis. Furthermore, there are few longitudinal studies which have correlated patient specific factors to catch-up growth. We aimed to determine the frequency of testicular catch up-growth in adolescents with varicocele while also examining if patient specific factors such as BMI, BMI percentile, or height correlated with testicular catch-up growth. METHODS: A retrospective chart review found adolescent patients who presented to our institution with varicocele from 1997 to 2019. Patients between the ages of 9 and 20 years with left-sided varicocele, a clinically significant testicular size discrepancy, and at least two scrotal ultrasounds at least one year apart were included in analysis. Testicular size discrepancy of greater than 15% on scrotal ultrasound was considered clinically significant. Testicular size was estimated in volume (mL) via the Lambert formula. Statistical relationships between testicular volume differential and height, body mass index (BMI), and age were described with Spearman correlation coefficients (ρ). RESULTS: 40 patients had a testicular volume differential of greater than 15% at some point during their clinical course and were managed non-operatively with observation and serial testicular ultrasounds. On follow-up ultrasound, 32/40 (80%) had a testicular volume differential of less than 15%, with a mean age of catch up growth at 15 years (SD 1.6, range 11-18 years). There were no significant correlations between baseline testicular volume differential and baseline BMI (ρ = 0.00, 95% CI [-0.32, 0.32]), baseline BMI percentile (ρ = 0.03, 95% CI [-0.30, 0.34]), or change in height over time (ρ = 0.05, 95% CI [-0.36, 0.44]). DISCUSSION: The majority of adolescents with varicocele and testicular hypotrophy exhibited catch-up growth with observation, suggesting that surveillance is an appropriate form of management in many adolescents. These findings are consistent with previous studies and further indicate the importance of observation for the adolescent varicocele. Further research is warranted to determine patient specific factors that correlate with testicular volume differential and catch up growth in the adolescent varicocele.

The Relationship of Testicular Sonoelastography with Gonadotropin Hormone Levels and Sperm Parameters.

Background: Elastography is a non-invasive medical imaging technique that helps determine the stiffness of organs and other structures in our body. In this study, we investigated the effectiveness of elastography in the diagnosis of infertility. Aim: In this study, we aimed to examine the relationship between testicular elastography and hormonal parameters and sperm parameters. Patients and Methods: The study included 136 patients, 272 testicles were examined, and the mean age of the study participants was 30.1 years. Testicular tissue stiffness was measured by scrotal ultrasonographic shear wave elastography. Gonadotropin and testosterone hormones were measured from blood samples. Spermiogram parameters were studied manually. Results: The control group included 66 patients, and the varicocele group consisted of 70 patients. Testicular stiffness degrees of the control group were measured as 4.29 kPa for the right testis and 4.23 kPa for the left testis. The varicocele group was divided into grades 1, 2, and 3 according to physical examination. In group 1 (grade 1), the right testis was 4.07 ± 1.24 kPa and the left testis was 3.77 ± 0.98 kPa. In group 2 (grade 2), the right testis was 4.31 ± 1.40 kPa and the left testis was 3.98 ± 0.93 kPa. In group 3 (grade 3), the right testis was 4.73 ± 1.50 kPa and the left testis was 3.99 ± 1.68 kPa. Hormone and sperm parameters were not statistically significant when comparing the control and varicocele groups. There was no statistical significance between the testicular tissue stiffness degrees of the control and varicocele groups. Hormone and spermiogram findings were also similar in groups. Conclusion: It is known that varicocele leads to histological tissue changes in the testes. These changes result in tissue softness and loss while affecting sperm parameters and testosterone levels in a negative way. Before varicocele surgery, there is a need for new imaging methods with more sensitivity that can detect tissue changes in the testes.

Round Ligament Varicocele Masquerading as an Inguinal Hernia During Pregnancy.

Hernia is an exceedingly common pathology, to which inguinal hernias are frequently diagnosed. Though this entity is regularly seen, in pregnancy a different diagnosis must be excluded: round ligament varicocele (RLV). Round ligament varicocele has a similar presentation to inguinal hernia, and therefore is often misdiagnosed. Though misdiagnosis potentially occurs from a lack of knowledge of the disease, RLV has shown that it's at least as common as inguinal hernia in pregnancy. The issue with misdiagnosis occurs as there is significant difference in management; hernia may require operative intervention, while RLV follows a conservative course. Therefore, an accurate diagnosis is essential, and an incorrect diagnosis can be associated with an unnecessary operation and consequence. We present the case of a patient in her second trimester who was referred for surgery due to suspicion of an inguinal hernia, and review the literature for evaluation recommendations, appropriate diagnostic strategies, and management tactics for RLV.

Elastography and contrast-enhanced ultrasound to assess the effect of varicocelectomy: A case-controlled study.

To evaluate the changes in testicular stiffness and microcirculation caused by spermatic vein ligation in patients with varicocele, we conducted a case-controlled study. A total of 27 grade III left varicocele cases were enrolled. Testicular stiffness and perfusion were evaluated by shear wave elastography and contrast-enhanced ultrasound during subinguinal microscopic varicocelectomy. The external and the internal parenchyma of bilateral testes were selected to compare the shear wave velocity of bilateral testes during the spermatic vein ligation. We mapped and compared the intensity-time curves following bolus contrast injection three times in the same region of interest. Initially, the shear wave velocity of the left internal parenchyma was higher than the right side (1.10 ± 0.06 m/s vs. 1.00 ± 0.03 m/s). It decreased (1.09 ± 0.06 m/s) (p < 0.05) after ligation. Meanwhile, the left epididymis had the higher agent peak intensity (0.90 × 10E-5 AU), the largest area under the curve (80.20 × 10E-5 AU s), and the longest washout area (54.35 × 10E-5 AU s). In addition, the left internal parenchyma presented a sharper slope (0.18 × 10E-5 AU/s) (p < 0.05). In conclusion, the spermatic vein ligation improved the perfusion of the internal testicular parenchyma, but it could temporally deteriorate the stasis of the epididymis. These changes caused softer testicular parenchyma.

Doppler Ultrasonography - An Important Tool in Managing Patients With Varicocele and Secondary Infertility.

BACKGROUND/AIM: Doppler ultrasound was successfully implemented as part of the diagnostic plan of medical emergencies in scrotal pathology. This study aimed to investigate whether it could play an important role in managing not only varicocele, but patients with secondary infertility as well. PATIENTS AND METHODS: The current study included 135 patients with varicocele and infertility. Surgery was performed in 18 cases with painful varicocele, 15 cases with testicular hypotrophy, and 48 cases with infertility. RESULTS: Among cases with infertility who underwent surgery, aged between 19 and 36 years old, 80% showed a significant improvement in the spermogram after curing the varicocele. In patients over 36 years of age, only 42% had some improvement in the spermogram after surgery. In addition, after surgery, antispermatic antibodies showed a significant decrease in all patients. CONCLUSION: Varicocele and secondary infertility are a well-known pathology. While the role of Doppler ultrasonography is established in varicocele diagnosis, we found an important pool of patients with secondary infertility and asymptomatic varicocele that would not have been diagnosed in the absence of Doppler ultrasound investigations. Since the best results in fertility were observed in patients younger than 36 years of age, we reiterate the importance of Doppler ultrasonography in addressing infertility.

Is testicular microlithiasis associated with testicular pathologies in children?

PURPOSE: To analyze the association of testicular pathologies with TM. METHOD: The retrospective study included pediatric patients who underwent scrotal ultrasonography (US) due to complaints, including testicular pain, discomfort, swelling, scrotal redness in our clinic between June 2020 and January 2022. The patients were divided into two groups. Group 1; patients were diagnosed with testicular pathology or presented with testicular pain. Group 2; patients without testicular pathology or complaints. Patients were also classified as having undescended testis, epididymo-orchitis, varicocele and testicular pain without testicular pathology in group 1. Group 1 and subgroups of group 1 were compared with group 2 for the presence of TM. RESULTS: A total of 516 patients were included in the study. Median age at the time of US examination was 24 months (range 1 month-17 years). There was no significant difference between groups 1 and 2, and boys with undescended testis and group 2 with regard to the presence of TM (p = 0.85, p = 0.55, respectively). TM was significantly higher in patients who had undergone orchiopexy and presented with testicular pain compared to group 2 (p = 0. 013, p = 0.03, respectively). TM was not detected in patients with epididymo-orchitis, varicocele. CONCLUSION: We found no association between TM and testicular pathologies. Testicular pain may be a symptom of microlithiasis.

Is it important to measure the internal spermatic vein diameter after varicocelectomy? A self-controlled trial.

To analyse spermatic vein parameters and post-varicocelectomy diagnostic ultrasound methods by comparing pre- and post-operative ultrasound parameters and semen quality in patients undergoing varicocelectomy. Ultrasound and semen analyses were performed within 1 week before surgery and 3 months after surgery in 125 patients who underwent varicocelectomy for infertility. Patients were divided into three groups according to the post-operative internal diameter of the spermatic vein and reflux: recovery, dilatation, and reflux. Changes in semen quality before and after surgery were compared between groups. Sperm concentration, motility, and morphology were significantly improved (p < 0.05); however, semen volume did not improve (p > 0.05) in patients in the recovery and dilatation groups compared to those in patients before surgery. Sperm concentration, motility, and semen volume did not improve in patients in the reflux group compared with those in patients before surgery (p > 0.05). Logistic regression analysis revealed that the internal diameter of the spermatic vein and reflux duration were risk factors for post-operative spermatic vein dilatation without reflux. Ultrasonography after varicocelectomy should primarily be used to observe reflux, and should not be used as a diagnostic criterion for varicocele based on the internal diameter of the spermatic vein alone.

[Value of nomogram based on the ultrasonographic features of prostatic calcification and varicocele and serological indicators in differential diagnosis of prostate cancer].

OBJECTIVE: To explore the diagnostic performance of the nomogram based on the transabdominal ultrasonographic features of prostatic calcification and varicocele (VC) and serological indicators in differentiating PCa with BPH from simple BPH. METHODS: This retrospective study included 108 cases of PCa with BPH and 317 cases of simple BPH, all pathologically confirmed after surgery from January 2014 to December 2021. Using t test or χ2/Fisher test, we compared the clinicopathologic data, transabdominal ultrasonographic features of prostatic calcification, VC severity and serological indicators between the two groups of patients. We identified the significant independent factors for differentiating PCa with BPH from simple BPH by multivariate logistic regression analysis and constructed a nomogram for visualizing the differential diagnostic performance. RESULTS: There were significant differences in the types and diameters of prostatic calcification, PSA density (PSAD), total PSA (tPSA), VC severity, and serum testosterone level between the two groups (P < 0.05). The types of calcification, PSAD and VC severity were identified as independent factors for differentiating PCa with BPH from simple BPH. Nomogram analysis of the above factors showed a good predicting performance, with an AUC of 0.805, a sensitivity of 83.28% and a specificity of 70.37%. CONCLUSION: Transabdominal ultrasonographic features and types of prostatic calcification, PSAD and VC severity are correlated with the development and progression of PCa. Nomogram analysis of the above factors contributes to the differentiation of PCa with BPH from simple BPH.

Minimally Invasive Total Extraperitoneal Varicocele Repair: First Description in Children.

Introduction: The aim of this study was to report the first pediatric case series treated with minimally invasive total extraperitoneal varicocele (MITEV) repair using the total extraperitoneal (TEP) approach. Materials and Methods: Five male adolescents (12-17 years) were included in this study, all with left-sided Grade III varicoceles. A 5 mm camera port was inserted just below the umbilicus and two 5 mm working ports were used, one above the symphysis in the midline and the other in the left lateral hemiabdomen just below the arcuate line. Results: Operation time ranged from 47 to 61 minutes (mean: 53 minutes). There were no intra- or postoperative complications. The peritoneum was not perforated, and the abdominal cavity was not entered. Two patients had resolution from varicoceles on follow-up clinical examination and ultrasonography was performed 6 months after surgery. In 3 patients, long-term follow-up was pending. Conclusion: MITEV repair reflects a new minimally invasive access to the retroperitoneum in children with varicocele.

Peak retrograde flow a potential objective management tool to identify young adults with varicocele 'at risk' for a high sperm DNA fragmentation.

INTRODUCTION: Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who would benefit most from surgery. Since conventional semen parameters, have been limited in their ability to evaluate the negative effects of varicocele on fertility, specialized laboratory tests have emerged. OBJECTIVE: To identify clinical and ultrasound parameters (including PRF) which would negatively influence standard and functional semen variables in young adults with a varicocele. DESIGN: Prospective, cross-sectional observational study. SETTING: Antwerp University Hospital, Belgium. PATIENT(S): Young volunteers between 16 and 26 years, Tanner 5, were recruited. INTERVENTION(S): Every participant had a scrotal ultrasound to calculate testicular volumes. If a varicocele was present, the grade, vein diameter, peak retrograde flow (PRF) in supine position and spontaneous reflux in standing position were measured. All participants provided a semen sample. Standard semen parameters were analyzed and sperm DNA fragmentation. MAIN OUTCOME MEASURE(S): Of all clinical and ultrasound parameters tested, PRF was an objective tool identifying young adults with a varicocele. PRF was highlighted by the prevalence of SDF, both in the total and vital fractions of the spermatozoa, providing opportunities to manage such 'at-risk' adolescents/young adults. RESULT(S): Total SDF was significantly increased in grade 3 varicocele compared to grade 1 and 2 but no significant difference with vital SDF or standard descriptive semen parameters was seen. Total and vital SDF on the other hand were significantly increased when PRF was above 38.4 cm/s. Standard semen analysis showed no difference with PRF as an independent predictor. Testicular atrophy index, varicocele vein diameter and spontaneous reflux revealed no significant differences in both the descriptive and functional semen variables. DISCUSSION: Descriptive semen parameters showed no significant difference between the non-varicocele controls and the varicocele group with low and high PRF. Increased PRF negatively influenced sperm quality via increased DNA fragmentation both in the total as in the vital fractions of the semen. CONCLUSION(S): Of all clinical and ultrasound parameters tested, PRF was an objective non-invasive tool to identify varicocele patients at risk for a high SDF.

Contribution of pre-varicocelectomy color Doppler ultrasonography finding to surgery and its correlation with semen parameters.

BACKGROUND: This study aimed to determine the contribution of color Doppler ultrasonography (CDUS) performed before varicocelectomy to the success of surgical treatment and to evaluate the correlation between CDUS findings and semen parameters. METHODS: A total of 84 patients diagnosed with grade 3 left varicocele in our clinic between 2016 and 2018 were evaluated. The patients in whom the decision for varicocelectomy was based on only physical examination (PE) findings and abnormal semen analysis (SA) were defined as Group 1, while the patients undergoing varicocelectomy based on PE, CDUS and SA findings were defined as Group 2. The patients diagnosed with varicocele based on PE and CDUS findings who were included in a followup protocol due to normal semen parameters were defined as Group 3. RESULTS: In Group 1, there was a total of 28 patients and the mean number of ligated internal spermatic veins was 4.53 (range, 2-10). In Group 2, there was a total of 30 patients and the number of ligated internal spermatic veins was 3.76 (range, 1-8). No statistically significant difference was found between Group 1 and 2 in terms of the number of internal spermatic veins ligated during varicocelectomy. No statistically significant correlation was found between semen parameters and the number of veins ligated during varicocelectomy in Group 1 and 2 and between semen parameters and CDUS findings group 2 and 3. CONCLUSIONS: In patients with primary grade 3 varicocele, diagnosed by physical examination there is no need for additional imaging in primary cases.

Prospective evaluation of the association between varicocele and benign prostatic hyperplasia in men over 40 years of age.

We investigated the association between varicocele and benign prostatic hyperplasia in men over the age of 40 years. A total of 296 outpatients were evaluated. Prostate volume was measured with transrectal ultrasound. Varicocele was diagnosed by physical examination and ultrasound. Prostatic hyperplasia was defined as prostate volume greater than or equal to 40 ml. Two groups were compared: patients with prostate volume less than 40 ml and patients with prostate volume greater than or equal to 40 ml. There was a statistically significant difference between the groups in terms of mean age, post-void residual, International Prostate Symptom Score and PSA. The percentage of patients with clinical varicocele in the group with a volume less than 40 ml and the group with a volume equal to or greater than 40 ml was 38.2% and 47.7% respectively (p = .12). There were no differences between the two groups in the percentage of patients with clinical or subclinical varicocele (43.2% vs. 52.2%, respectively, p = .12). No differences were found in the percentage of patients with varicocele when comparing men with prostates smaller than 40 ml and greater than or equal to 40 ml.