Resident of Radiology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
Int Urol Nephrol. 2020 Dec;52(12):2245-2251. doi: 10.1007/s11255-020-02566-z. Epub 2020 Aug 29.
Many attempts are being made to find an association between varicocele characteristics and sperm parameters. In this study, we investigated the association between a newly introduced varicocele reflux grading pattern and sperm parameters, as well as its effect on spermogram improvement after varicocelectomy.
In a prospective study, 73 patients with a clinical single-sided varicocele who underwent corrective varicocelectomy were included. Reflux pattern was determined on Color Doppler Ultrasound (CDUS) and categorized into four grades: grade 1 (retrograde), grade 2 (augmentation), grade 3 (enhancement), and grade 4 (stasis). The association of pre- and postoperative spermogram with the patients' reflux pattern was evaluated.
A significant positive association was found between the venous diameter and reflux pattern. Higher grades of the reflux pattern were associated with the more severe hemodynamic pattern of the reflux (shunt type). A significant association was found between the reflux pattern and preoperative semen characteristics, and this association was more prominent in constant venous diameter. In this respect, the enhancing reflux type was associated with the most impaired preoperative sperm count, motility, and morphology. The enhancing type also revealed the most improvement in spermogram after varicocelectomy.
Patients with a higher reflex grade, particularly enhancing pattern, will most benefit from the surgical correction of varicocele. These findings suggest reflux pattern as a promising prognostic factor for a favorable outcome after varicocelectomy.
许多尝试都旨在寻找精索静脉曲张特征与精子参数之间的关联。本研究旨在探讨新引入的精索静脉曲张反流分级模式与精子参数之间的关系，以及其对精索静脉曲张手术后精子质量改善的影响。
在一项前瞻性研究中，纳入了 73 例接受精索静脉曲张矫正手术的单侧临床精索静脉曲张患者。在彩色多普勒超声（CDUS）上确定反流模式，并分为四级：1 级（逆行）、2 级（增强）、3 级（增强）和 4 级（停滞）。评估术前和术后精子图与患者反流模式的相关性。
静脉直径与反流模式呈显著正相关。反流模式的等级越高，反流的血流动力学模式越严重（分流型）。反流模式与术前精液特征之间存在显著相关性，在恒定静脉直径时这种相关性更为明显。在这方面，增强型反流与术前精子计数、活力和形态最差相关。增强型反流在精索静脉曲张手术后精子图的改善也最为显著。
反流等级较高的患者，特别是增强型反流，将从精索静脉曲张手术矫正中获益最大。这些发现表明反流模式是精索静脉曲张手术后良好结果的有前途的预后因素。
