Ultrasound Evaluation of Varicocele: Correlating Surgical Interventions with Improvements in Semen Quality

Varicocele, a dilatation in the pampiniform plexuses brought on by retrograde flow, has historically been reported to be close to 16% in the male population and to be between 35 and 45% in men who are infertile. To assess the effect of microsurgical varicocelectomy on semen parameters and compare the results of pre-operative ultrasound results and surgical results.

This was a cross-sectional study that involved 106 infertile men (mean age 29.5 +-4.8 years) who had palpable Grade II-III varicoceles and abnormal semen analysis. Standardized scrotal Doppler ultrasound, which measured the maximum venous diameter, reflux, the number of pampiniform plexus veins, and the volume of testicles, was conducted on all patients. Every patient was then subjected to subinguinal microsurgical varicocelectomy.

The semen parameters have been improved: the concentration was raised to 24.8 ± 16.5 million/mL, and total motility was raised to 44.8 ± 15.1%. In total, in 84.0% of patients (89/106), the improvement occurred in at least one of the parameters. The risk of improvement was higher in patients with less concentrations of lower baseline concentrations (OR 1.62 per 5 million/mL decrease) and less motility of lower baseline motility (OR 1.78 per 10% decrease). The pre-operative ultrasound results in the presence of more pampiniform plexus veins strongly predicted an increase in post-operative sperm concentration. There was a tendency towards increased mean improvement of concentration in Grade III (+12.3 million/mL) as compared to Grade II (+7.8 million/mL) varicoceles (p=0.049). The observed natural pregnancy rates at 12 months stand at 29.2% and the overall complication rate was 13.2% which were mainly minor.

Microsurgical varicocelectomy is associated with a great enhancement of semen concentration and motility in infertile men with clinical varicocele. The value of pre-operative ultrasound and, specifically, the determination of the number of pampiniform plexus veins gives useful prognostic data, and certain sonographic patterns are associated with the level of benefit in surgery. Individuals with a higher severity of baseline oligospermia or asthenozoospermia gain the most benefit.