Abolhasani Foroughi Amin, Dallaki Manoochehr, Hosseini Seyed Ali, Ariafar Ali
Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Reprod Infertil. 2022 Apr-Jun;23(2):84-92. doi: 10.18502/jri.v23i2.8992.
Varicoceles are a major cause of infertility. The purpose of this study was to determine the relationship of the clinical and ultrasonographic grades of varicocele with the semen analysis profile and testicular volume among men undergoing scrotal ultrasonography.
This cross-sectional analytical study involved 109 males undergoing scrotal ultrasonography for various indications in Shiraz, Iran, between January 2019 and January 2020. Varicoceles were graded with color Doppler ultrasonography (CDU) by an expert radiologist (Sarteschi's criteria) before an experienced urologist determined the clinical grade (Dubin and Amelar criteria) and requested further investigations. Next, the demographics, reasons for referral, testicular volumes, and semen analysis profiles across the different clinical/ultrasonographic grades were compared. Key statistical measures included Cohen's kappa coefficient, the Mann-Whitney and Kruskal-Wallis tests, and Spearman correlation. Data were analyzed using SPSS v. 21 with p-values <0.05 indicating statistical significance.
Ultrasonographic grades 1 and 2 provided the highest correlation with subclinical cases, while ultrasonographic grades 3, 4, and 5 corresponded with clinical grades 1, 2, and 3, respectively. Further comparisons were made between subclinical and clinical cases, which were similar in terms of reason for referral, total testicular volume, testicular volume differential, and semen analysis profile. Notably, total testicular volumes below 30 were associated with oligoasthenoteratospermia.
The present study showed a relatively high correlation between varicocele grading based on clinical evaluation and CDU. However, the grades were similar in testicular volume parameters and semen analysis indices. Hence, decision-making should be guided by the infertility history, testicular atrophy, and abnormal semen analysis.
精索静脉曲张是导致男性不育的主要原因。本研究旨在确定接受阴囊超声检查的男性精索静脉曲张的临床分级和超声分级与精液分析结果及睾丸体积之间的关系。
本横断面分析研究纳入了2019年1月至2020年1月期间在伊朗设拉子因各种适应证接受阴囊超声检查的109名男性。在经验丰富的泌尿科医生确定临床分级（杜宾和阿梅拉尔标准）并要求进一步检查之前，由一名专业放射科医生使用彩色多普勒超声（CDU）对精索静脉曲张进行分级（萨特eschi标准）。接下来，比较了不同临床/超声分级的人口统计学特征、转诊原因、睾丸体积和精液分析结果。主要统计指标包括科恩kappa系数、曼-惠特尼检验和克鲁斯卡尔-沃利斯检验以及斯皮尔曼相关性分析。使用SPSS v. 21软件进行数据分析，p值<0.05表示具有统计学意义。
超声分级1级和2级与亚临床病例的相关性最高，而超声分级3级、4级和5级分别对应临床分级1级、2级和3级。对亚临床病例和临床病例进行了进一步比较，两者在转诊原因、总睾丸体积、睾丸体积差异和精液分析结果方面相似。值得注意的是，总睾丸体积低于30 与少弱畸精子症相关。
本研究表明，基于临床评估的精索静脉曲张分级与CDU分级之间具有较高的相关性。然而，在睾丸体积参数和精液分析指标方面，分级情况相似。因此，决策应依据不育病史、睾丸萎缩和异常精液分析结果来指导。
