The clinical usefulness of a novel grading system for varicocoeles using duplex Doppler ultrasound examination based on postsurgical modifications of seminal parameters

摘要

Background The existing classifications of varicocoeles have poor predictive value regarding the effects of surgery on sperm count. Objective To develop a new grading system for varicocoeles, useful as an indication for surgery. Materials and methods This is a three-center prospective study which examined 173 men having clinically detectable left varicocoeles and oligo +/- astheno +/- terato-spermia. The patients underwent medical history collection, objective examination, duplex Doppler ultrasound scrotal examination, hormonal profiles, two semen analyses before surgery, and two semen analyses after surgery. Sperm concentration, motility, and morphology (standard semen parameters) were evaluated 6 months after surgery in function of the following preoperative variables: patient age, follicle-stimulating hormone, clinical grade of varicocoele, right and left testicular volume, extension of venous reflux, and semen parameters. The venous reflux was graded in two centers using duplex Doppler ultrasound: reflux visible only with Valsalva and continuous reflux. Spearman's rank semiquantitative analysis was used. All patients had their varicocoeles corrected according to the Colpi technique. Results The variables capable of determining an improvement in semen parameters after varicocoele correction were in order of decreasing importance: venous reflux extent assessed by scrotal duplex Doppler ultrasound examination, varicocoele clinical grade, basal semen parameters, and follicle-stimulating hormone. Male age did not influence postoperative semen quality. Only patients with continuous reflux had their standard semen parameters improved after surgery. Discussion Venous reflux extent is the most critical variable capable of predicting semen improvement after varicocoelectomy. Conclusions A correct duplex Doppler assessment of venous reflux is mandatory for predicting postoperative improvement of the sperm count.