No abstract available.
Diagnosis* ; Ultrasonography* ; Varicocele*

PURPOSE: The objective of this study was to evaluate the accuracy of color Doppler ultrasonography (CDU) and to assess the effects of microsurgical bilateral varicocelectomy on patients diagnosed with a left varicocele by CDU. MATERIALS AND METHODS: 69 patients with varicocele were enrolled between March 2005 and May 2007. The patients were randomized into 2 groups: group I-preoperative bilateral varicoceles were diagnosed by color CDU, and group II-only a left varicocele was diagnosed by CDU. All patients underwent an inguinal microsurgical varicocelectomy bilaterally. Statistical analysis was performed by paired Student's t-test and one way ANOVA. RESULTS: Mean age of the patients was 27.5+/-7.9 years. After surgery, semen parameters were significantly improved in sperm number in group I (p=0.002) and semen volume in group II (p<0.005). At the time of surgery, we found that 16 (88.9%) of 18 patients had bilateral varicoceles in group II. The accuracy of CDU to diagnose varicoceles was not perfect. CONCLUSIONS: The bilateral microsurgical varicocelectomy in patients with only a left varicocele diagnosed by CDU significantly increased their semen volume. Most (88.9%) patients diagnosed with a left varicocele actually had bilateral varicoceles. Therefore, microsurgical bilateral varicocelectomy may be appropriate for infertile men with a left varicocele diagnosed by CDU.
Humans ; Male ; Semen ; Sperm Count ; Ultrasonography, Doppler, Color ; Varicocele

PURPOSE: The objective of this study was to evaluate the accuracy of color Doppler ultrasonography (CDU) and to assess the effects of microsurgical bilateral varicocelectomy on patients diagnosed with a left varicocele by CDU. MATERIALS AND METHODS: 69 patients with varicocele were enrolled between March 2005 and May 2007. The patients were randomized into 2 groups: group I-preoperative bilateral varicoceles were diagnosed by color CDU, and group II-only a left varicocele was diagnosed by CDU. All patients underwent an inguinal microsurgical varicocelectomy bilaterally. Statistical analysis was performed by paired Student's t-test and one way ANOVA. RESULTS: Mean age of the patients was 27.5+/-7.9 years. After surgery, semen parameters were significantly improved in sperm number in group I (p=0.002) and semen volume in group II (p<0.005). At the time of surgery, we found that 16 (88.9%) of 18 patients had bilateral varicoceles in group II. The accuracy of CDU to diagnose varicoceles was not perfect. CONCLUSIONS: The bilateral microsurgical varicocelectomy in patients with only a left varicocele diagnosed by CDU significantly increased their semen volume. Most (88.9%) patients diagnosed with a left varicocele actually had bilateral varicoceles. Therefore, microsurgical bilateral varicocelectomy may be appropriate for infertile men with a left varicocele diagnosed by CDU.
Humans ; Male ; Semen ; Sperm Count ; Ultrasonography, Doppler, Color ; Varicocele

Varicocele is now a well established common cause of the male infertility and is a curable disease. Scrotal ultrasonography is a simple and reliable method for the diagnosis of varicocele because of noninvasiveness to the patient. Thus the urologists and radiologists try to use various diagnostic tools including physical examination to confirm significant varicoceles objectively. We used scrotal ultrasonography as a objective diagnostic method to evaluate 19 varicocele patients. Of 19 patients 17 had e palpable left varicocele clinically and a patient had bilateral varicoceles. All the clinical varicoceles were confirmed readily by sonography. By the sonography one case was demonstrated a left varicocele as a subclinical patient with infertility.
Diagnosis ; Humans ; Infertility ; Infertility, Male ; Male ; Physical Examination ; Ultrasonography* ; Varicocele*

PURPOSE: To assess the ability of scrotal Doppler ultrasonography to confirm the diagnosis of clinical varicoceles and detect subclinical varicoceles. MATERIALS AND METHOD: Sixty patients with clinically evident varicocele were examined by scrotal doppler ultrasonography(gray scale: 60 patients, spectral Doppler: 35 patients, color Doppler: 22 patients). A control group of 21 patients with no suspected scrotal pathology also were studied. The age range of the varicocele group was 12-49 years. The normal group consisted of 21 subjects aged 19-23 years. Ultrasonographic measurement of scrotal vein diameter of patients before and during Valsalva maneuver, and scrotal vein blood flow reversal with Valsalva maneuver was compared with the findings of varicocele by physical examination. RESULTS: Significant differences were found in scrotal vein diameter before and during Valsalva maneuver between normal and varicocele testicular units. Cut-off points were selected in an arbitrary fashion on the basis of scattergram. Using this cut-off points and blood flow reversal, we found that 12(23%) of 53 patients with a clinically palpable left unilateral varicocele had an ultrasonographically positive subclinical right varicocele. 8(38%) of 21 patients without a clinical varicocele had a positive scrotal ultrasound. CONCLUSIONS: We suggest that scrotal doppler ultrasonography is a reliable means of confirming the clinical varicocele and screening the subclinical varicoceles.
Diagnosis ; Humans ; Mass Screening ; Pathology ; Physical Examination ; Ultrasonography ; Ultrasonography, Doppler* ; Valsalva Maneuver ; Varicocele* ; Veins

PURPOSE: Retrograde flow is the main criterion for the diagnosis of varicocele, and the Duplex Doppler ultrasonographic values for retrograde flows are poorly defined. The purpose of this study is to assess a relationship between the palpated varicocele and pampiniform plexus diameter and the retrograde flow that was investigated with performing Duplex Doppler ultrasonography (DDU). MATERIALS AND METHODS: Physical examinations and DDU were performed to assess varicoceles in forty patients with left-sided varicocele and also in eight men who were without varicocele on their physical examination. During both normal respiration and the Valsalva's maneuver, the maximum diameters of the pampiniform plexus and the presence of the retrograde flow were measured by DDU. RESULTS: The highest mean venous diameter in the patients with clinical grade III varicocele was 2.7mm (2.4-3.6), and this was significantly higher than that in the patients with grade I (1.9mm) or with grade II varicocele (2.1mm) (p<0.05). While the difference of diameters between grade I and grade II was not significant, venous reflux was found in all degrees of the varicocele veins. Venous reflux during the Valsalva maneuver (type II flow pattern) was detected on the right side in one (8%) of 13 patients with grade II varicocele, and in three (21%) of 14 patients with grade III varicocele. The type III flow patterns, indicating augmenting of the reflux with an intra-abdominal pressure increase, were 46.1%, 69.2% and 100% for grade I, II and III, respectively. No venous reflux was found in the control group. CONCLUSIONS: The presence of retrograde flow may provide a more reliable indicator than does the spermatic vein diameter for the diagnosis of varicocele. When the palpability of the pampiniform plexus is questionable, Duplex Doppler ultrasound is indicated.
Diagnosis ; Humans ; Male ; Physical Examination ; Respiration ; Testis ; Ultrasonography ; Ultrasonography, Doppler, Duplex ; Valsalva Maneuver ; Varicocele* ; Veins

PURPOSE: The benefits of varicocelectomy in improving semen quality and pregnancy rate has been clearly demonstrated. However, the reports on the effects of varicocelectomy in patient with painful varicocele are few. We evaluate the efficacy of varicocelectomy with modified Palomo method and microsurgical subinguinal method in these patients. MATERIAL AND METHODS: 109 consecutive patients who underwent varicocelectomy with follow up period more than 3 months were enrolled in the study. We analyzed the degree of varicocele, effects of surgical treatment and results according to surgical technique and grade of varicocele. The result was classified into completely resolved, partially resolved and unchanged based on the relief of pain. The outcome of varicocelectomy was assessed retrospectively either by review of patient's medical records or telephone and letter interview. RESULTS: Of 109 patients, 43 patients (39.4%) underwent varicocelectomy with modified Palomo method and microsurgical subinguinal method for pain. Of those 43 patients, 34 (79.0%) reported complete resolution of pain postoperatively, 4 patients (9.4%) showed partial resolution, 5 patients (11.6%) showed no change. Of the 5 patients with no change, 3 patients had no abnormal finding by postoperative ultrasonography and remaining 2 patients had recurrence of varicocele. There were no statistically significant differences in resolution rate between two surgical methods and among each grade (Chi-square test; p=0.749, 0.690). CONCLUSIONS: Surgical treatment of varicocele is an effective treatment for relief of pain in properly selected patients.
Follow-Up Studies ; Humans ; Medical Records ; Pregnancy Rate ; Recurrence ; Retrospective Studies ; Semen Analysis ; Telephone ; Ultrasonography ; Varicocele*

Testicular microlithiasis (TM) is an uncommon abnormality in which concentric laminated bodies are scattered throughout the testis within seminiferous tubules. The sonographic appearance of TM is characteristic. In a retrospective analysis of 281 testicular sonograms, TM were found in 7 cases (2.5%). The presence of TM was associated with the presence of acute epididymitis (n=3), varicocele (n =l), hydrocele (n =l), testicular tumor (n =l), and cryptorchidism (n =l). The pathogenesis of TM is still poorly understood and its clinical relevance is unclear. However, because TM may be associated with testicular tumor, we advocate careful evaluation and follow up of the testes when this abnormality is detected.
Cryptorchidism ; Epididymitis ; Follow-Up Studies ; Male ; Retrospective Studies ; Seminiferous Tubules ; Testis ; Ultrasonography ; Varicocele

OBJECTIVETo investigate the objective index of the diagnosis of varicocele (VC) in infertile males by ultrasonography and the testis volume changes resulting from varicocele.

METHODSForty-six healthy male volunteers and 178 infertile men with left varicocele were detected by high frequency ultrasound. According to the clinical data and ultrasonographic results, the 178 VC patients were divided into 4 groups, SVC group (45 cases), VC I group (44 cases), VC II group (48 cases), and VC III group (41 cases).

RESULTS(1) The differences in DR, DV, Vmax, TR and testis volume between the right and the left sides were not statistically significant in the control group (P > 0.05). (2) The differences in DR, DV, Vmax and TR between the experimental and control groups as well as among the VC groups were statistically significant (P < 0.001). (3) The left testis volume was smaller than the right among the VC groups (P < 0.01). The right testis volume of the VC II and VC III groups was significantly smaller than that of the control group ( P < 0.05), and the left testis volume in the VC III group was significantly smaller than that of the SVC group (P < 0.05).

CONCLUSION(1) High frequency ultrasound can detect the accurate diameter of the internal spermatic vein, hemodynamic index and testis volume of infertile men with VC, and hence help to screen the causes of male infertility. (2) Unilateral varicocele can cause a volume decrease in both testes, especially in the left. Both unilateral SVC and VC can cause testicular atrophy, and the more serious VC, the higher testicular atrophy.

Adult ; Humans ; Infertility, Male ; diagnostic imaging ; Male ; Testis ; diagnostic imaging ; Ultrasonography, Doppler, Color ; Varicocele ; diagnostic imaging

PURPOSE: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. RESULTS: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. CONCLUSION: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.
Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Prospective Studies ; Semen/metabolism ; Testicular Diseases/ultrasonography ; Ultrasonography, Doppler, Color/*methods ; Varicocele/pathology/*ultrasonography ; Veins/*ultrasonography ; Young Adult