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Real-time scrotal ultrasound of patients with varicoceles: correlation with impaired semen analysis

  • Urogenital
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Abstract

Objectives

To evaluate the potential relationship between scrotal ultrasound findings and abnormal semen analysis.

Methods

Eighty-seven patients with varicoceles underwent semen analysis and scrotal sonography. On ultrasound, estimated testes volume and the largest pampiniform vein diameters on the affected side at rest and with Valsalva manoeuvre in both the supine and upright positions were examined. In addition, the differences between the largest venous diameters at rest and during the Valsalva manoeuvre in each position (supine and upright) and also the differences between the largest venous diameter in the supine position and the upright position in each condition (at rest and during the Valsalva manoeuvre) were calculated. The relationship between various ultrasound parameters and impaired semen analysis was evaluated using receiver operating characteristic curves.

Results

Seventy-one patients had spermatogenesis impairment, and the remaining 16 had normal semen analysis. The difference in the mean spermatic vein diameter at rest between the supine and upright positions (cut-off point, 0.25 mm) had the highest diagnostic accuracy in differentiating the patients with abnormal sperm analysis from those with normal spermatogenesis with an area under the curve of 0.86.

Conclusions

Real-time scrotal ultrasound can be helpful in predicting abnormal sperm analysis in patients with varicoceles.

Key Points

• Scrotal ultrasound is a non-invasive method to evaluate spermatic veins in varicoceles.

• Ultrasound can evaluate venous dimension change at rest after upright position (ΔD R ).

• ΔD R   > 2.5 mm distinguishes patients with abnormal semen analysis.

• ΔD R has the most accuracy in predicting abnormal spermatogenesis.

• Ultrasound findings improve differentiation between patients with abnormal and normal spermatogeneses.

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

D SR :

Largest spermatic vein diameter in supine position at rest

D SV :

Largest spermatic vein diameter in supine position following Valsalva manoeuvre

D UR :

Largest spermatic vein diameter in upright position at rest

D UV :

Largest spermatic vein diameter in upright position following Valsalva manoeuvre

ΔD S :

D SV minus D SR

ΔD U :

D UV minus D UR

ΔD R :

D UR minus D SR

ΔD V :

D UV minus D SV

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

SD:

Standard deviation

YI:

Youden’s index

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Acknowledgments

The authors would like to thank Dr. Shahed Rezaian, Dr. Asal Vahabi Moghaddam and Ms. Samaneh Esmaeili for their valuable help during the current study.

The scientific guarantor of this publication is Dr. Ali Babaei Jandaghi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Mr. Mirmahmood Hafezi kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. The study subjects or cohorts have not been previously reported. Methodology: prospective, case–control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran

    Ali Babaei Jandaghi, Hamid Moradi & Amin Keshavarz Zirak

  2. Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran

    Ali Hamidi Madani & Hamidreza Nasseh

  3. Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ramin Pourghorban

Authors
  1. Ali Babaei Jandaghi
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  2. Hamid Moradi
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  3. Ali Hamidi Madani
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  4. Hamidreza Nasseh
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  5. Amin Keshavarz Zirak
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  6. Ramin Pourghorban
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Correspondence to Ramin Pourghorban.

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Babaei Jandaghi, A., Moradi, H., Hamidi Madani, A. et al. Real-time scrotal ultrasound of patients with varicoceles: correlation with impaired semen analysis. Eur Radiol 24, 2245–2251 (2014). https://doi.org/10.1007/s00330-014-3218-6

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  • DOI: https://doi.org/10.1007/s00330-014-3218-6

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