Physiological Characteristics of Testicular Venous Blood Flow and Associated Structural Changes in Individuals with Varicocele

Abstract

Varicocele is known to be associated with infertility and sperm disorders. The exact mechanism behind these mal effects is yet not clear, especially the relationship of testicular blood flow and semen quality parameters. Objective of the study was to evaluate testicular blood flow pattern and spermatic cord microanatomy of infertile individuals with varicocele and to find their correlation/association with semen quality. Sixty consecutive patients between 20–45 years age, diagnosed with infertility and varicocele, undergoing microsurgical varicocelectomy at Fatima Memorial Hospital Lahore, were included in the study. Semen quality parameters and scrotal color Doppler ultrasonography (CDUS) were recorded preoperatively. During surgery, microanatomy of the spermatic cord was observed. The outcomes of semen analysis were sperm count, motility and morphology. The testicular blood flow was determined as peak systolic velocity (PSV) and resistive index (RI) of sub capsular artery and intra parenchymal artery of the testes by scrotal CDUS. During microsurgery, anatomy of varicocele veins, testicular artery, arterio-venous micro communications, lymphatics and their arrangement was recorded. Result revealed that of 60 patients, mean sperm count, progressive motility and morphology were 29.6±24.26 million/mL, 16.47±14.53% and 5.18±5.47% respectively. The mean varicocele diameters were 3.26±0.85 and 3.72 ± 1.10 mm at lying position and at standing posture with valsalva maneuver respectively. No significant correlation was found between semen quality parameters and varicocele vein diameter. Similarly there was no correlation between the sperm count and testicular blood flow parameters. A negative correlation was found between progressive