Testicular Arterial Blood Flow Volume in Predicting Semen Improvement Following Microscopic Subinguinal Varicocelectomy

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2024 Oct 21

PMID 39429572

Authors

Wei Fu

Jun Cui

Shaoshan Tang

Affiliations

Soon will be listed here.

Abstract

Background: Varicocele is a significant but treatable contributor to male infertility. The efficacy of varicocelectomy in improving sperm quality is not consistent, with only 60-80% of patients experiencing improved semen quality. This prospective cohort study aimed to evaluate the effect of microscopic subinguinal varicocelectomy (MSV) on testicular arterial blood flow volume (TABFV) and to determine the value of preoperative TABFV in predicting the outcome of MSV.

Methods: Patients with varicocele who underwent MSV at the same clinical center between July 2020 and April 2023 were enrolled. All patients underwent ultrasound assessment and at least one semen analysis before and after MSV. Both univariate and multivariate logistic regression analyses were performed to assess the association between pre-MSV variables and semen improvement after MSV. Subsequently, a diagnostic model was developed.

Results: This study enrolled 96 patients with varicocele, including 31 who showed semen improvement after MSV and 65 who did not. The postoperative semen-improved group demonstrated a significant increase in TABFV of the right testis (TABFV-R) and left testis (TABFV-L) (P<0.001). Notably, the postoperative TABFV-L was more than twice the preoperative TABFV-L. Preoperative TABFV-R and a combination of subclinical right-sided varicocele were found to be associated with semen improvement after MSV, and a diagnostic model was developed using these two variables. The diagnostic model exhibited satisfactory performance, with an area under the curve (AUC) of 0.824 [95% confidence interval (CI): 0.735-0.913], which was further validated internally yielding an AUC of 0.824 (95% CI: 0.726-0.900). Additionally, calibration analysis confirmed that the diagnostic model was well calibrated, and the Hosmer-Lemeshow test resulted in a P value of 0.794. The decision curve demonstrated that using this proposed nomogram would yield a net benefit if the threshold probability for semen improvement after MSV exceeded 10%.

Conclusions: TABFV-L demonstrated potential utility in clinical practice for assessing outcomes of MSV, and the diagnostic model incorporating TABFV-R and a combination of right-side varicocele performed well in predicting improvements in semen parameters following MSV.

Citing Articles

Surgical Efficacy in Varicocele Ligation with Ephedrine-Assisted Blood Pressure Control.

Wang J, Wang J, Wang H, Chen B, Wang X, Xu P Med Sci Monit. 2025; 31:e946234.

PMID: 39955613 PMC: 11840970. DOI: 10.12659/MSM.946234.

References

Matthews G, Matthews E, Goldstein M . Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril. 1998; 70(1):71-5. DOI: 10.1016/s0015-0282(98)00108-3. View

DUBIN L, AMELAR R . Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril. 1970; 21(8):606-9. DOI: 10.1016/s0015-0282(16)37684-1. View

Collins G, Reitsma J, Altman D, Moons K . Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. 2015; 350:g7594. DOI: 10.1136/bmj.g7594. View

Abdel-Meguid T, Al-Sayyad A, Tayib A, Farsi H . Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol. 2011; 59(3):455-61. DOI: 10.1016/j.eururo.2010.12.008. View

Tarhan S, Gumus B, Gunduz I, Ayyildiz V, Goktan C . Effect of varicocele on testicular artery blood flow in men--color Doppler investigation. Scand J Urol Nephrol. 2003; 37(1):38-42. DOI: 10.1080/00365590310008677. View

Atmoko W, Savira M, Shah R, Chung E, Agarwal A . Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review. Transl Androl Urol. 2024; 13(2):260-273. PMC: 10932644. DOI: 10.21037/tau-23-397. View

Hamilton J, Cissen M, Brandes M, Smeenk J, de Bruin J, Kremer J . Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system. Hum Reprod. 2015; 30(5):1110-21. DOI: 10.1093/humrep/dev058. View

Shomarufov A, Bozhedomov V, Sorokin N, Matyukhov I, Fozilov A, Abbosov S . Predictors of microsurgical varicocelectomy efficacy in male infertility treatment: critical assessment and systematization. Asian J Androl. 2022; 25(1):21-28. PMC: 9933953. DOI: 10.4103/aja2021125. View

Shah R, Agarwal A, Kavoussi P, Rambhatla A, Saleh R, Cannarella R . Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations. World J Mens Health. 2022; 41(1):164-197. PMC: 9826919. DOI: 10.5534/wjmh.220048. View

10.

Sun X, Wang J, Peng Y, Gao Q, Song T, Yu W . Bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a prospective randomized controlled study. Int Urol Nephrol. 2017; 50(2):205-210. DOI: 10.1007/s11255-017-1749-x. View

11.

Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz N . European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol. 2021; 80(5):603-620. DOI: 10.1016/j.eururo.2021.08.014. View

12.

Van Calster B, Wynants L, Verbeek J, Verbakel J, Christodoulou E, Vickers A . Reporting and Interpreting Decision Curve Analysis: A Guide for Investigators. Eur Urol. 2018; 74(6):796-804. PMC: 6261531. DOI: 10.1016/j.eururo.2018.08.038. View

13.

Lima T, Frech F, Patel P, Blachman-Braun R, Ramasamy R . Effect of microsurgical varicocelectomy on semen parameters, serum, and intratesticular testosterone levels. BJUI Compass. 2020; 1(3):93-99. PMC: 7357880. DOI: 10.1002/bco2.15. View

14.

Cannarella R, Shah R, Hamoda T, Boitrelle F, Saleh R, Gul M . Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data. World J Mens Health. 2023; 42(1):92-132. PMC: 10782123. DOI: 10.5534/wjmh.230034. View

15.

Chiou R, Anderson J, Wobig R, Rosinsky D, Matamoros Jr A, Chen W . Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1998; 50(6):953-6. DOI: 10.1016/S0090-4295(97)00452-4. View

16.

Shafik A, Bedeir G . Venous tension patterns in cord veins. I. In normal and varicocele individuals. J Urol. 1980; 123(3):383-5. DOI: 10.1016/s0022-5347(17)55945-5. View

17.

Alsaikhan B, Alrabeeah K, Delouya G, Zini A . Epidemiology of varicocele. Asian J Androl. 2016; 18(2):179-81. PMC: 4770482. DOI: 10.4103/1008-682X.172640. View

18.

Almekaty K, Zahran M, Zoeir A, Minhas S, Salem K . The role of artery-preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study. Andrology. 2019; 7(2):193-198. DOI: 10.1111/andr.12580. View

19.

. Report on varicocele and infertility. Fertil Steril. 2004; 82 Suppl 1:S142-5. DOI: 10.1016/j.fertnstert.2004.05.057. View

20.

Sweeney T, Rozum J, Gore R . Alteration of testicular microvascular pressures during venous pressure elevation. Am J Physiol. 1995; 269(1 Pt 2):H37-45. DOI: 10.1152/ajpheart.1995.269.1.H37. View