Preoperative and Intraoperative Scrotal Duplex Ultrasound in the Assessment of Varicocele: A Comparative Study

ORIGINAL ARTICLE

 
For citation: Mohamed RR, Hussein RS. Preoperative and Intraoperative Scrotal Duplex Ultrasound in the Assessment of Varicocele: A Comparative Study. International Journal of Biomedicine. 2024;14(1):99-103. doi:10.21103/Article14(1)_OA15
 
Originally published March 1, 2024

Abstract: 

Background: This study aimed to compare the accuracy of preoperative and intraoperative scrotal duplex ultrasound (SDU) in assessing varicocele, a common cause of male subfertility.
Methods and Results: The study was conducted on 20 male patients scheduled for subinguinal varicocelectomy at a tertiary care hospital from March 2022 to March 2023. We used Grey-Scale US and Doppler US to evaluate testicular size, vein diameter, arterial flow parameters, and retrograde flow. We found that the preoperative scrotal duplex was a good and accurate method for assessing the grading of varicocele, and there was no significant difference in vein diameter or venous reflux between preoperative and intraoperative assessments. However, we observed a significant increase in the number of veins and testicular volume during intraoperative SDU compared to preoperative scrotal SDU.
Conclusion: SDU is a reliable tool for determining testicular volume and provides objective, accurate, and reproducible measurements of testicular volume.

Keywords: 
varicocele • infertility • varicocelectomy • scrotal duplex ultrasound
References: 
  1. Paick S, Choi WS. Varicocele and Testicular Pain: A Review. World J Mens Health. 2019 Jan;37(1):4-11. doi: 10.5534/wjmh.170010. Epub 2018 May 16. PMID: 29774668; PMCID: PMC6305863.
  2. Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian J Androl. 2016 Mar-Apr;18(2):179-81. doi: 10.4103/1008-682X.172640. PMID: 26763551; PMCID: PMC4770482.
  3. Arafa M, Henkel R, Agarwal A, Majzoub A, Elbardisi H. Correlation of oxidation-reduction potential with hormones, semen parameters and testicular volume. Andrologia. 2019 Jun;51(5):e13258. doi: 10.1111/and.13258. Epub 2019 Feb 26. PMID: 30809834.
  4. Leslie SW, Sajjad H, Siref LE. Varicocele. 2023 Nov 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28846314.
  5. Hannick JH, Blais AS, Kim JK, Traubici J, Shiff M, Book R, Lorenzo AJ. Prevalence, Doppler Ultrasound Findings, and Clinical Implications of the Nutcracker Phenomenon in Pediatric Varicoceles. Urology. 2019 Jun;128:78-83. doi: 10.1016/j.urology.2019.03.001. Epub 2019 Mar 16. PMID: 30885542.
  6. Babaei Jandaghi A, Moradi H, Hamidi Madani A, Nasseh H, Keshavarz Zirak A, Pourghorban R. Real-time scrotal ultrasound of patients with varicoceles: correlation with impaired semen analysis. Eur Radiol. 2014 Sep;24(9):2245-51. doi: 10.1007/s00330-014-3218-6. Epub 2014 May 24. PMID: 24852814.
  7. Shakeri S, Malekmakan L, Manaheji F, Tadayon T. Inter-observer agreement on varicoceles diagnosis among patients referred to Shiraz Namazi Hospital. Int J Reprod Biomed. 2018 Oct;16(10):649-652. PMID: 30643858; PMCID: PMC6314647.
  8. Kim YS, Kim SK, Cho IC, Min SK. Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis. Korean J Urol. 2015 Feb;56(2):144-9. doi: 10.4111/kju.2015.56.2.144. Epub 2015 Jan 30. PMID: 25685302; PMCID: PMC4325119.
  9. Oyen RH. Scrotal ultrasound. Eur Radiol. 2002 Jan;12(1):19-34. doi: 10.1007/s00330-001-1224-y. Epub 2001 Nov 22. PMID: 11868071.
  10.  Sarteschi M. Lo studio del varicocele con eco-color-Doppler. G It Ultrason. 1993;4:43-49.‏
  11. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril. 1992 Jun;57(6):1289-93. PMID: 1601152.
  12. Prader A. Testicular size: assessment and clinical importance. Triangle. 1966;7(6):240-3. PMID: 5920758.
  13. Arslan H, Sakarya ME, Atilla MK. Clinical value of power Doppler sonography in the diagnosis of varicocele. J Clin Ultrasound. 1998 May;26(4):229. doi: 10.1002/(sici)1097-0096(199805)26:4<229::aid-jcu13>3.0.co;2-e. PMID: 9572392.
  14. Hopps CV, Lemer ML, Schlegel PN, Goldstein M. Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol. 2003 Dec;170(6 Pt 1):2366-70. doi: 10.1097/01.ju.0000097400.67715.f8. PMID: 14634418.
  15. Gonda RL Jr, Karo JJ, Forte RA, O'Donnell KT. Diagnosis of subclinical varicocele in infertility. AJR Am J Roentgenol. 1987 Jan;148(1):71-5. doi: 10.2214/ajr.148.1.71. PMID: 3024475.
  16. Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Matamoros A Jr, Chen WS, Taylor RJ. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1997 Dec;50(6):953-6. doi: 10.1016/S0090-4295(97)00452-4. PMID: 9426729.
  17. Kocakoc E, Serhatlioglu S, Kiris A, Bozgeyik Z, Ozdemir H, Bodakci MN. Color Doppler sonographic evaluation of inter-relations between diameter, reflux and flow volume of testicular veins in varicocele. Eur J Radiol. 2003 Sep;47(3):251-6. doi: 10.1016/s0720-048x(02)00182-1. PMID: 12927671.
  18. Özkaptan O, Balaban M, Sevinc C, Çubuk A, Sahan A, Akca O. Impact of intra-operative doppler ultrasound assistance during microsurgical varicocelectomy on operative outcome and sperm parameters. Andrologia. 2020 Aug;52(7):e13641. doi: 10.1111/and.13641. Epub 2020 May 7. PMID: 32379354.
  19. Juho YC, Wu ST, Kao CC, Meng E, Cha TL, Yu DS. Anatomic mapping of the internal spermatic vein via subinguinal varicocelectomy with intraoperative vascular Doppler ultrasound. J Chin Med Assoc. 2019 Feb;82(2):115-119. doi: 10.1097/JCMA.0000000000000012. PMID: 30839501.
  20. Hsieh ML, Huang ST, Huang HC, Chen Y, Hsu YC. The reliability of ultrasonographic measurements for testicular volume assessment: comparison of three common formulas with true testicular volume. Asian J Androl. 2009 Mar;11(2):261-5. doi: 10.1038/aja.2008.48. Epub 2009 Jan 19. PMID: 19151736; PMCID: PMC3735018.
  21. Paltiel HJ, Diamond DA, Di Canzio J, Zurakowski D, Borer JG, Atala A. Testicular volume: comparison of orchidometer and US measurements in dogs. Radiology. 2002 Jan;222(1):114-9. doi: 10.1148/radiol.2221001385. PMID: 11756714.
  22. Mbaeri TU, Orakwe JC, Nwofor AM, Oranusi KC, Mbonu OO. Accuracy of Prader orchidometer in measuring testicular volume. Niger J Clin Pract. 2013 Jul-Sep;16(3):348-51. doi: 10.4103/1119-3077.113460. PMID: 23771459.
  23. Behre HM, Nashan D, Nieschlag E. Objective measurement of testicular volume by ultrasonography: evaluation of the technique and comparison with orchidometer estimates. Int J Androl. 1989 Dec;12(6):395-403. doi: 10.1111/j.1365-2605.1989.tb01328.x. PMID: 2696729.
  24. Schiff JD, Li PS, Goldstein M. Correlation of ultrasonographic and orchidometer measurements of testis volume in adults. BJU Int. 2004 May;93(7):1015-7. doi: 10.1111/j.1464-410X.2003.04772.x. PMID: 15142154.
  25. Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and testicular function: comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility. Asian J Androl. 2008 Mar;10(2):319-24. doi: 10.1111/j.1745-7262.2008.00340.x. Epub 2007 Dec 20. PMID: 18097521.
  26. Fuse H, Takahara M, Ishii H, Sumiya H, Shimazaki J. Measurement of testicular volume by ultrasonography. Int J Androl. 1990 Aug;13(4):267-72. doi: 10.1111/j.1365-2605.1990.tb01031.x. PMID: 2201649.

Download Article
Received January 13, 2024.
Accepted February 17, 2024.
©2024 International Medical Research and Development Corporation.