Ultrasonography of the testicles in the context of laparoscopic treatment of left-sided varicocele
DOI:
https://doi.org/10.15574/PS.2022.74.79Keywords:
varicocele, laparoscopic varicocelectomy, ultrasound examination, testiclesAbstract
Purpose - to determine significant sonographic pathogenetic markers of infertility formation in left-sided varicocele of II-III grades and their dynamics after laparoscopic varicocelectomy in the context of fertility restoration.
Materials and methods. In the study, 214 patients with left-sided varicocele II-III grades and 25 practically healthy men aged 19 to 33 years were examined. All patients underwent laparoscopic varicocelectomy.
The testes volume, the resistance index in the intratesticular arteries, and the diameter of the varicose veins of the left spermatic cord at rest in a horizontal position on the back with the head raised by 15° and during the Valsalva maneuver in a vertical position. During Valsalva maneuver also determined the duration and rate of venous blood reflux in the testes.
Results. Ultrasound in patients with left varicocele II-III grades confirmed deterioration of hemodynamics in the spermatic cord and testis. According to the results of sonography in patients with left varicocele II-III grades identified significant prognostic markers of testicular lesions: RI>0.66, VD>2.4 mm, VDvm>3 mm, VRFvm>2 cm/s, and DVR>1.1 s. The negative dynamics of these indicators are an indication for the correction of varicocele, and their normalization in the postoperative period indicates the effectiveness of treatment.
Conclusions. Testicular ultrasound is more informative than palpation. In patients of reproductive age with left-sided varicocele II-III grades sonography diagnoses testicular tissue damage in the early stages of the disease. It should be used as a non-invasive screening method for a comprehensive examination to determine testicular lesions and for monitoring in the context of fertility prognosis after varicocelectomy.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
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