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1.
Eur Radiol ; 30(1): 11-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332561

RESUMO

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.


Assuntos
Infertilidade Masculina/diagnóstico por imagem , Escroto/diagnóstico por imagem , Varicocele/diagnóstico por imagem , Consenso , Medicina Baseada em Evidências , Humanos , Infertilidade Masculina/etiologia , Masculino , Pênis/diagnóstico por imagem , Espermatogênese/fisiologia , Ultrassonografia , Varicocele/complicações
2.
Int Urol Nephrol ; 51(11): 1925-1932, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31388902

RESUMO

OBJECTIVES: The study summarizes the effectiveness of ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome (NCS)-associated varicocele. METHODS: Cases of NCS-associated varicocele were recruited between December 2012 and December 2018. Prior to the operation, all patients were tested for the internal diameter and blood flow velocity of left renal vein, testicular volume, maximum venous diameter and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver by Color Doppler ultrasound. Moreover, the direction of left spermatic and inferior epigastric vein was marked. RESULTS: All patients underwent ligation of the internal spermatic veins and left spermatic-inferior epigastric vein anastomosis under microscopy. Color Doppler ultrasound, urinary and semen analysis (above age 18 years old) were reviewed during the follow-up period. 53 patients (94.6%) underwent spermatic-inferior epigastric vein anastomosis with the mean operation time of 78.4 ± 14.2 min. The hospital stay was 4-7 days. Scrotal hydrocele, wound infection and testicular atrophy did not occur after operation. However, there were 5 cases of left varicocele recurrence and 2 cases of vascular anastomotic thrombosis. 51 cases had decrease in blood peak flow rate of left renal vein and improvement in nutcracker syndrome while scrotal bulge symptoms resolved in 26 cases. 10 cases had microscopic hematuria disappearance with symptom improvement in 2 cases. 19 cases of left testicular hypotrophy experience no further deterioration after surgery, of which 16 cases had catch-up testicular growth. CONCLUSION: Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis assisted is safe, easy and effective for treating nutcracker syndrome-associated varicocele.


Assuntos
Microcirurgia , Cirurgia Assistida por Computador , Ultrassonografia Doppler em Cores , Ultrassonografia de Intervenção , Varicocele/diagnóstico por imagem , Varicocele/cirurgia , Adolescente , Anastomose Cirúrgica/métodos , Criança , Humanos , Masculino , Estudos Prospectivos , Síndrome do Quebra-Nozes/complicações , Testículo/irrigação sanguínea , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/etiologia , Procedimentos Cirúrgicos Vasculares/métodos , Veias , Adulto Jovem
3.
Presse Med ; 48(4): 419-434, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31097262

RESUMO

Genital venous insufficiency in men is usually of constitutional origin due to valvular incontinence. Genital venous insufficiency in female is more often generated by major, lasting, and possibly repeated pregnancy-related hyperpressure phenomena. Genital venous insufficiency in men is usually expressed by visible and recognizable peritesticular varicocele. Of simple anatomic structure, it is easily accessible to endovascular treatment by embolization, which is the first-line therapy nowadays. Genital venous insufficiency in women results in a pelvic predominant varicosis, which should be evoked in case of chronic pelvic pain or atypical venous afferents to the lower limbs. Precise and guided interrogation and clinical examination allow the attending physician to be the first actor in the detection of symptomatic pelvis venous insufficiency in men and women. A chronic pelvic pain in female should evoke a pelvic congestion syndrome, symptomatic translation of pelvic varicosis, especially if it increases at the end of the day, at the effort, in pre-menstrual period. Treatment with endovascular embolization is the only therapeutic option for female pelvic venous insufficiency, of complex architecture and deep anatomical situation. The interventional radiologist offers a complete, minimally invasive and efficient treatment with limited hospital costs and perioperative constraints.


Assuntos
Hiperemia/diagnóstico por imagem , Hiperemia/terapia , Radiologia Intervencionista , Varicocele/diagnóstico por imagem , Varicocele/terapia , Varizes/diagnóstico por imagem , Varizes/terapia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/terapia , Embolização Terapêutica , Feminino , Humanos , Masculino , Pelve , Síndrome
4.
Andrologia ; 51(7): e13293, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30995701

RESUMO

In the present study, we compared the retroperitoneal high ligation with subinguinal varicocelectomy on the treatment of painful varicocele. A total of 90 patients who underwent retroperitoneal high ligation (n = 45) and subinguinal varicocelectomy (n = 45) for painful varicocele were included in this prospective study. Varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography. All the patients underwent a conservative treatment for pain for 4 weeks. Patient ages, varicocele grades, preoperative pain scores, postoperative pain scores at 6 months, duration of surgeries, complications and recurrences were recorded. Complete success rate for chronic scrotal pain was found to be 80% in retroperitoneal varicocelectomy group and 71% in subinguinal varicocelectomy group. Partial success rate was 11% for retroperitoneal varicocelectomy group and 18% for subinguinal ligation group. There was no significant difference between two groups in terms of pain and complications. However, the operation time was significantly lower in the Palomo group. Although microsurgical subinguinal varicocelectomy is the current approach for the treatment of varicocele, retroperitoneal high ligation can achieve the same pain resolution with shorter operative duration compared to loupe-assisted subinguinal varicocelectomy.


Assuntos
Dor Crônica/terapia , Microcirurgia/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adolescente , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Masculino , Microcirurgia/métodos , Duração da Cirurgia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Espaço Retroperitoneal , Estudos Retrospectivos , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Escroto/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos , Adulto Jovem
5.
Urol Int ; 103(1): 55-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30991395

RESUMO

AIM: The aim of the study was an assessment of the effects of varicocele on testis parenchyma and microcirculation with the use of the dynamic tissue perfusion measurements. METHODS: Color Doppler sonographic dynamic testis parenchyma perfusion measurements were performed with Pixel-Flux software in 30 children with left testis varicocele. The right testes without varicocele comprised the control group. RESULTS: Testicular parenchymal perfusion in testes with varicocele was reduced when compared to the control testes. The differences were found in all measured perfusion parameters. Statistical significance was found in the case of mean velocity and resistance index parameters. According to the grade of varicocele, the perfusion was the most reduced in patients with grade III of varicocele. CONCLUSION: Testicular parenchymal perfusion decreases in patients with varicocele, mostly in higher grades of varicocele. In case of validation, the method can be used in determining the damage of the testis with varicocele and the need for surgery.


Assuntos
Testículo/diagnóstico por imagem , Testículo/fisiopatologia , Ultrassonografia Doppler em Cores , Varicocele/diagnóstico por imagem , Varicocele/fisiopatologia , Adolescente , Criança , Humanos , Masculino , Microcirculação , Perfusão , Software
6.
J Chin Med Assoc ; 82(2): 115-119, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30839501

RESUMO

BACKGROUND: Varicocele is believed to be a dilated vein of the pampiniform plexus along the spermatic cord. Surgical treatment should be considered in men with a symptomatic varicocele. To date, microsurgical varicocelectomy is the most effective method among various varicocelectomy techniques, according to the current evidence. This study aimed to evaluate the effectiveness of subinguinal varicocelectomy with intraoperative vascular Doppler for symptomatic varicocele and map the distributional trend of spermatic content simultaneously. METHODS: A total of 24 male patients underwent subinguinal varicocelectomy with intraoperative vascular Doppler ultrasound between March 2016 and October 2017, because of symptomatic varicocele or infertility. The numbers, sizes, and location of spermatic vessels in each site were recorded during operation. The visual analogue scale (VAS) score of scrotal pain was also obtained before and after surgery. RESULTS: The mean number of spermatic veins that were ligated in each spermatic unit was 4.70 (±2.06). The predominant distributional zone of spermatic veins was the medial upper zone on an axial view of the spermatic cord. Fifty-six (44.1%) spermatic veins were found in this zone. Normally, each spermatic cord has 1.33 (±0.61) spermatic arteries. The average VAS score prior to surgery was 1.95 (±0.89) and it decreased to 0.05 (±0.21) after the surgery. Complete resolution of pain was observed in almost all symptomatic patients (95.23%). A significant positive relationship between the number of veins ligated and improvement of VAS score was also noted (p < 0.05). CONCLUSION: Subinguinal varicocelectomy with intraoperative vascular Doppler ultrasound is an effective treatment for symptomatic varicocele. The more the internal spermatic veins are ligated, the more the VAS scores are improved. Determining the distributional trend of spermatic content is of great importance in the prevention of iatrogenic injury to the spermatic vessels and vas deferens.


Assuntos
Cordão Espermático/irrigação sanguínea , Ultrassonografia Doppler/métodos , Varicocele/cirurgia , Veias/diagnóstico por imagem , Adulto , Humanos , Masculino , Monitorização Intraoperatória , Varicocele/diagnóstico por imagem , Veias/anatomia & histologia , Escala Visual Analógica
7.
BMC Urol ; 19(1): 14, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704438

RESUMO

BACKGROUND: An acute scrotal hematoma, secondary to a spontaneous rupture of a varicocele is still a rare presentation in daily practice. However, multiple case reports have been reported. Sudden increase in abdominal pressure, resulting to an increased venous pressure can lead to a rupture of the varicocele. Literature search shows that due to uncertainty of the diagnosis, explorative surgery is often performed, sometimes resulting in unnecessary orchiectomies. The objective of this study was to determine classical clinical presentation of patients with a spontaneous rupture of a varicocele, determine the diagnostic procedure, and give an insight in the follow-up. CASE PRESENTATION: We present a case of a 24-year old male with acute scrotal swelling after sneezing. Subsequently, we carried out a systematic literature search to identify all eligible studies to determine classic clinical presentation of spontaneous ruptures of a varicocele. CONCLUSION: The literature search shows that clinical presentation of idiopathic spontaneous scrotal hematomas is similar to testicular torsion, epididymo-orchitis, malignancy, or (incarcerated) inguinal hernia making differential diagnosis difficult. Especially when there has been increased abdominal pressure or strenuous activity preceding the symptoms, and the swelling is left sided, it should be included in the differential diagnosis for patient with acute inguinoscrotal swelling. Colour Doppler-Ultrasonography is recommended to distinguish between other causes of acute scrotum. The hematoma is usual self-limiting, justifying conservative treatment. Early surgical intervention is indicated with signs of ischaemia due to obstruction, infection of the hematoma, or uncertain diagnosis (i.e. malignancy). However, physicians should be cautious with direct exploration, as it led to unnecessary orchiectomy in 25% of patients. The hematoma can increase in size up to 3 months post-event, and it can take up to 15 months to completely resolve.


Assuntos
Hematoma/diagnóstico por imagem , Ruptura/diagnóstico por imagem , Escroto/diagnóstico por imagem , Espirro , Varicocele/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Ruptura/etiologia , Ruptura/cirurgia , Escroto/cirurgia , Espirro/fisiologia , Varicocele/etiologia , Varicocele/cirurgia , Adulto Jovem
8.
AJR Am J Roentgenol ; 212(4): 802-807, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30779666

RESUMO

OBJECTIVE: Unilateral left varicoceles are common and considered benign. Unilateral right varicoceles are reportedly associated with a pathologic process, namely malignancy affecting the retroperitoneum, for which further imaging is often recommended. The purpose of this study was to test the hypothesis that this correlation between unilateral right varicocele and malignancy may be weaker than once suggested, particularly in the absence of other clinical signs of malignancy. MATERIALS AND METHODS: Medical charts and imaging at one institution were reviewed for all patients reported to have right varicocele. Follow-up cross-sectional imaging and clinical records and surgical and medical history were reviewed for possible nonmalignant or malignant causes of varicocele. RESULTS: Ninety-six patients with unilateral right varicocele diagnosed by means of ultrasound were identified. Twenty-nine (30.2%) patients were excluded because of confounding factors (infection, testicular mass, intrascrotal surgery). Among the other 67, 55 had available follow-up information, 39 with cross-sectional imaging. Right-sided varicocele was attributable to nonmalignant causes in 16 of the 55 subjects (29.1%) and to malignancy in two subjects: one with metastatic disease of undetermined primary and one with confluent liver masses. Both patients presented with other signs of malignancy and represented only 3.6% of the cohort who underwent follow-up. CONCLUSION: In this cohort, patients with right-sided varicocele attributable to malignancy presented with additional signs of metastatic disease. Nonmalignant causes were more common. Therefore, confounding conditions should be considered when incidental isolated right varicocele is identified. Health care costs, patient anxiety, and unnecessary harm can be substantially reduced through modulation of follow-up recommendations based on additional findings at presentation.


Assuntos
Varicocele/diagnóstico por imagem , Varicocele/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia , Varicocele/patologia
9.
J Ultrasound Med ; 38(6): 1619-1627, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30244482

RESUMO

We illustrate the intravascular ultrasound (US) findings in the evaluation of left gonadal vein anatomic variations. During a 2-year period, 4 consecutive patients (mean age, 37 years; range, 28-45 years) with left-sided varicocele underwent embolization. Intravascular US examinations and retrograde venography were performed to assess varicocele anatomy. Anatomic variants were recorded and categorized. A comparison between intravascular US and fluoroscopic findings was performed. The Fisher exact test was used for statistical analysis (P < .05). Technical success was achieved in all cases. There was a statistically significant difference in the maximum gonadal vein diameter between venography and intravascular US (P = .0087). Intravascular US showed left gonadal vein anatomic variations and better ability in the evaluation of the vein diameter.


Assuntos
Embolização Terapêutica/métodos , Gônadas/irrigação sanguínea , Gônadas/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Varicocele/diagnóstico por imagem , Varicocele/terapia , Adulto , Feminino , Gônadas/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Reprod Domest Anim ; 54(2): 270-274, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30246894

RESUMO

Ultrasonography was used to capture a coronal-sagittal image of the veins of the pampiniform plexus (PP) and the testicular artery of 327 maternal-line boars at approximately 6 months of age at the University of Nebraska-Lincoln. Varicocoele was diagnosed by two methods. Method 1 diagnosed varicocoele when the average vessel area on one side of the scrotum was 1.5 times larger than the average vessel area on the other side of the scrotum. Method 2 diagnosed varicocoele when the average vessel area on one side of the scrotum of a boar was 1.5 times larger than the average vessel on the same side of the scrotum of the boar's cohorts (same population and year). Varicocoele was diagnosed in 23.17% and 15.1% of boars measured using method 1 and method 2, respectively. Ultrasonography showed to be an effective means to measure PP vessel size in boars and may even allow for earlier detection of varicocoele than by using palpation. Animal models were employed to estimate the heritability for: average area of right PP vessels (0.52), average area of the left PP vessels (0.46), varicocoele presence using method 1 (0.26) and varicocoele presence using method 2 (0.25). These heritability estimates suggest that vessel size and varicocoele could be selected against in breeding programmes to potentially improve boar semen quality.


Assuntos
Característica Quantitativa Herdável , Escroto/irrigação sanguínea , Testículo/irrigação sanguínea , Varicocele/genética , Varicocele/patologia , Animais , Masculino , Escroto/diagnóstico por imagem , Análise do Sêmen , Suínos , Testículo/diagnóstico por imagem , Ultrassonografia , Varicocele/diagnóstico por imagem , Veias
11.
Andrologia ; 51(1): e13161, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30318780

RESUMO

The aim of this study was to evaluate the structural changes in testicles of the patients with varicocele by strain elastography (SE) and to identify the relationship between semen analysis and hormone levels considering SE results. The patients were separated into two groups as varicocele and control, according to their physical examination and the scrotal colour duplex ultrasonography results. All patients underwent examination by hormonal profile, semen analysis, colour duplex ultrasonography and sonoelastography. Testicular volume, resistive index (RI) of intratesticular arterial flow, strain rate and varicocele measurements were recorded. The left testicle strain ratios (SR) median value was 0.18 (0.15-0.26) in the varicocele group and 0.25 (0.19-0.28) in the control group (p < 0.001). The median RI value was 0.59 (0.52-0.64) in the varicocele group and 0.52 (0.5-0.59) in the control group (p < 0.001). No difference was found considering volume between the right and left testicles in either group. These results showed that elastography could be useful to detect the damage caused by varicocele on testicles in early period. However, studies with more patients would help to increase elastography's value and reliability.


Assuntos
Testículo/fisiopatologia , Varicocele/fisiopatologia , Adulto , Técnicas de Imagem por Elasticidade/métodos , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Análise do Sêmen , Motilidade Espermática , Testículo/diagnóstico por imagem , Ultrassonografia , Varicocele/diagnóstico por imagem , Adulto Jovem
13.
World J Urol ; 37(7): 1461-1465, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30324297

RESUMO

OBJECTIVE: Inhere, we compared two of the most common grading systems based on color Doppler ultrasonography (CDU) and physical examination in patients suspected of varicocele. METHODS: This is a cross-sectional study. Overall, 66 patients clinically suspected of varicocele were visited by an attending urologist and a radiologist for physical examination and CDU. Varicocele was then graded according to the WHO criteria and Sarteschi criteria. For comparing the results of the two grading systems, each grading systems was then categorized into four scoring groups. Clinical- and CDU-based scoring, and mean maximum variceal vein diameter (MMVD) were evaluated and compared. RESULTS: The two scoring systems were statistically similar (p < 0.001). CDU scoring of right and left testicles had significant agreement with clinical scoring of varicocele (κ = 0.723 and κ = 0.809, respectively; p < 0.001). MMDV was associated with clinical (right sided: r = 0.681; left sided: r = 0.797; p < 0.001) and ultrasonography scoring (right sided: r = 0.648; left sided: r = 0.821; p < 0.001). CONCLUSION: Grades zero, one and two in ultrasonographic grading are most compatible with grade zero (sub-clinical) in clinical evaluation; so these grades most probably remain undetected in routine physical examination. Furthermore, grade three in ultrasonography and grade one in clinical grading, grade four in ultrasonography and grade two in clinical grading, and finally grade five in ultrasonography and grade three in clinical grading are most compatible. So, by deducting two grades from the ultrasonography grading of varicocele measured by the Sarteschi method, one can obtain a compatible estimate of the clinical grading.


Assuntos
Exame Físico , Ultrassonografia Doppler em Cores , Varicocele/diagnóstico , Adolescente , Adulto , Estudos Transversais , Humanos , Masculino , Índice de Gravidade de Doença , Varicocele/diagnóstico por imagem , Adulto Jovem
14.
J Ultrasound Med ; 38(3): 621-627, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30171622

RESUMO

OBJECTIVES: To evaluate testes in patients with varicocele using real-time strain elastography and to correlate the results with the patients' clinical, seminal, and hormonal profiles. METHODS: Fifty patients with left varicocele and 20 age-matched control participants were included in the study. All participants were evaluated via a historical interview, clinical examination, including testicular volume and varicocele grade, hormonal assay (total and free testosterone, luteinizing hormone, and follicle-stimulating hormone), computer-assisted semen analysis, and testicular assessment using real-time strain elastography to define the strain ratio and elasticity score. RESULTS: Testicular volume and sperm parameters were significantly lower (P < .001), whereas the follicle-stimulating hormone level, strain ratio, and elasticity score were significantly higher (P < .01; P < .001; P < .001, respectively), in the varicocele group. Other hormone levels in the endocrine profile were not significantly different between the groups. Significant negative correlations were found between the elasticity score and testicular volume and the percentage of normal forms (P = .029; P = .005). The varicocele grade showed significant positive correlations with both the strain ratio and elasticity score (P < .001). CONCLUSIONS: Strong correlations were found between real-time strain elastography and the testicular volume, varicocele grade, and sperm morphologic characteristics. Real-time strain elastography is a simple, noninvasive investigative modality that can potentially be used to study the structure and function of the testicular tissue in varicocele.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Testículo/diagnóstico por imagem , Varicocele/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Humanos , Masculino , Reprodutibilidade dos Testes
15.
Andrologia ; 51(3): e13197, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30461039

RESUMO

We aimed to evaluate the use of diffusion-weighted imaging (DWI) in the assessment of the varicocele effect on testicular parenchyma and spermatogenesis, with estimation of apparent diffusion coefficient (ADC) value changes in the testicular parenchyma. We prospectively evaluated 30 consecutive patients (18 patients with bilateral varicocele and 12 patients with unilateral varicocele) and 10 healthy controls. US and DWI were performed to all patients. A total of 80 testes were included, which divided into three groups: group A: testes ipsilateral to the varicocele (n = 48, 60%); group B: testes contralateral to the varicocele (n = 12, 15%); and group C: normal testes of the control (n = 20, 25%). There was a statistically significant difference in mean ADC value between all groups (p-value < 0.001). In groups A and B, there was a negative correlation between mean ADC values and varicocele grade as well as pampiniformis venous diameter. In group A, there was a significant positive correlation between mean ADC value and sperm count (p-value = 0.01, r-value = 0.48) as well as sperm motility (p-value = 0.04, r-value = 0.33). DWI sequence can be used to evaluate the sequel of varicocele, with decreased ADC values that are significantly correlated with abnormal semen parameters. Thus, ADC values may be considered as an ancillary indicator of testicular parenchyma changes.


Assuntos
Testículo/diagnóstico por imagem , Varicocele/diagnóstico por imagem , Adulto , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Motilidade Espermática , Testículo/fisiopatologia , Varicocele/fisiopatologia , Adulto Jovem
16.
Andrologia ; 51(3): e13210, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30556169

RESUMO

A noninvasive imaging technique providing information about testicular dysfunction in testes with varicocele would be useful. The aim is to measure the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in testes of infertile men with varicocele and to assess interobserver agreement. Sixteen infertile men with varicocele and 14 age-matched controls underwent 1.5 T diffusion tensor imaging (DTI) MRI. Testicular ADC and FA were measured by two radiologists independently. Parametric and nonparametric statistical tests were applied to compare between the ADC and FA of testes with varicocele and normal testes. Interobserver agreement was evaluated. The interobserver variability for ADC (0.915) and FA (0.948) was very good. No differences in ADC (p = 0.294) were found between the two groups. FA was significantly lower in testes with varicocele compared to age-matched controls (p < 0.001). An optimal cut-off of FA 0.08 was found for the diagnosis of varicocele (sensitivity = 88%, specificity = 93.5%, positive predictive value = 91.6% and negative predictive value = 90.6%). Based on our results, FA is useful for the diagnosis of testes in infertile men with varicocele, with very good interobserver agreement. Therefore, DTI may be used as a noninvasive imaging tool in the work-up of varicocele.


Assuntos
Infertilidade Masculina/diagnóstico por imagem , Testículo/diagnóstico por imagem , Varicocele/diagnóstico por imagem , Adulto , Anisotropia , Imagem de Tensor de Difusão , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
BMC Urol ; 18(1): 104, 2018 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-30424751

RESUMO

BACKGROUND: Varicocele is known to be associated with infertility and sperm disorders. The exact cause of this ailment is not fully understood. There are limited numbers of studies where venous blood gases (VBGs) of varicocele veins were determined with conflicting results. Therefore, we have investigated the pattern of VBGs in both internal spermatic and external spermatic varicocele veins and correlation with semen quality parameters in infertile individuals who underwent left microsurgical varicocelectomy. METHODS: Patients (n = 27) undergoing left microsurgical varicocelectomy at a tertiary care hospital, were included in the study. Before surgery, semen parameters and scrotal color Doppler ultrasonography was performed. During surgery, blood sample was drawn from varicocele veins (internal spermatic and external spermatic veins) and a peripheral arm vein of the same patient as a control. The VBGs of all veins under study were estimated and compared with each other. The VBGs were also correlated with various semen quality parameters. Data, expressed as Mean ± SD, regarding VBGs in three veins were analyzed using one-way ANOVA. The correlation between VBGs and semen quality parameters was determined using Pearson's correlation. Differences were considered significant at p < 0.05. RESULTS: The pH was found to be higher (p < 0.01) in the internal spermatic vein compared with the external spermatic and the peripheral veins. Partial pressure of oxygen (pO2) and oxygen saturation (sO2) were higher (p < 0.01) in the internal spermatic vein compared with the peripheral vein. However, concentration of bicarbonate (HCO3) was lower (p < 0.01) in both veins compared with the peripheral vein. Partial pressure of carbon dioxide (pCO2) was also lower (p < 0.01) in the varicocele veins compared with the control vein. CONCLUSION: The internal spermatic veins had higher pH and oxygen tension, but lower HCO3 and pCO2 levels compared with the control peripheral veins. External spermatic veins had lower pCO2 and HCO3 but other VBGs were similar to the peripheral veins. The shift of VBGs of internal spermatic vein toward arterial blood pattern may be a missing link to understand the pathophysiology of varicocele.


Assuntos
Microcirurgia/métodos , Varicocele/sangue , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Gasometria/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Sêmen/diagnóstico por imagem , Sêmen/metabolismo , Análise do Sêmen/métodos , Cordão Espermático/irrigação sanguínea , Cordão Espermático/diagnóstico por imagem , Cordão Espermático/cirurgia , Varicocele/diagnóstico por imagem , Adulto Jovem
20.
Rev Int Androl ; 16(4): 137-142, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30286867

RESUMO

INTRODUCTION: The mean platelet volume (MPV) is an extensively employed laboratory indicator related to platelet volume and function in inflammatory circumstances. The aim of this study was to assess the relationship between inflammation and mean platelet volume in varicocele pathophysiology. METHODS: We conducted a recent study, which included 131 varicocele subjects and 82 healthy controls. The identification of varicocele was based on the results from both physical examination and color Doppler ultrasound. We analyzed some laboratory markers including haemogram tests in two groups. RESULTS: There were no significant differences in the two groups in terms of baseline characteristics. MPV values were statistically higher in the varicocele group (9.73±0.86fL) than in the control group (9.03±0.70fL) (p<0.001). However, no significant relationship between MPV and varicocele grade was found. Furthermore, the receiver-operating characteristic curve analysis suggested the optimum MPV cut-off value for patients with varicocele as 9.05, with a sensitivity and specificity of 77% and 50%, respectively (p<0.001). CONCLUSION: MPV can offer information on varicocele pathophysiology. Increased MPV levels in varicocele patients may be associated with inflammation.


Assuntos
Inflamação/patologia , Volume Plaquetário Médio/métodos , Ultrassonografia Doppler em Cores/métodos , Varicocele/fisiopatologia , Adulto , Biomarcadores/metabolismo , Estudos de Casos e Controles , Humanos , Inflamação/diagnóstico por imagem , Masculino , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Varicocele/diagnóstico por imagem , Adulto Jovem
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