Wang Anmin, Chang Hongyuan, Luo Dicheng, Wang Hao, Lv Hui, Yu Wenxiao, Wang Fu
Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, 100091, China.
Basic Clin Androl. 2025 Jun 2;35(1):20. doi: 10.1186/s12610-025-00268-z.
Varicocele adversely affects male fertility by impairing semen quality, yet there remains no unified approach that combines advanced imaging and laboratory markers for clinical stratification. To develop a uniform clinical stratification system, we conducted a review of the literature across major databases.
Shear wave elastography thresholds above 5.235 kPa and spermatic vein diameters exceeding 2.5 mm on color Doppler ultrasound demonstrated strong, independent correlations with decreased sperm concentration, motility, and morphology. Among laboratory tests, elevated follicle-stimulating hormone, low inhibin B, and others were consistently linked to poorer semen quality. Biomarkers such as cysteine-rich secretory protein 3 showed potential.
We propose a multimodal stratification framework integrating evidence‑based cutoffs for shear wave elastography and color Doppler ultrasound with key laboratory indices. Adoption of standardized protocols and consensus guidelines will facilitate personalized diagnosis, improve prognostic accuracy, and guide management of varicocele‑decreased semen quality.
精索静脉曲张通过损害精液质量对男性生育能力产生不利影响，但目前尚无将先进成像技术与实验室指标相结合用于临床分层的统一方法。为了开发一个统一的临床分层系统，我们对各大数据库的文献进行了综述。
剪切波弹性成像阈值高于5.235千帕以及彩色多普勒超声显示精索静脉直径超过2.5毫米与精子浓度、活力和形态的降低具有强烈的独立相关性。在实验室检查中，促卵泡生成素升高、抑制素B降低等与较差的精液质量始终相关。富含半胱氨酸的分泌蛋白3等生物标志物显示出潜力。
我们提出了一个多模式分层框架，将基于证据的剪切波弹性成像和彩色多普勒超声的临界值与关键实验室指标相结合。采用标准化方案和共识指南将有助于个性化诊断，提高预后准确性，并指导精索静脉曲张所致精液质量下降的管理。
