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Hemodynamic evaluation of left testicular varicocele by scrotal scintigraphy
K Minayoshi1, H Okada, M Fujisawa
1Department of Urology, Kobe University School of Medicine, Kobe, Japan.
Insights
Varicocele hemodynamics, assessed by time-activity curves (TAC), impact spermatogenesis. TAC-1 and TAC-2 patterns indicate better outcomes after varicocelectomy compared to TAC-3.
Area of Science:
- Urology
- Radiology
- Reproductive Medicine
Background:
- Left testicular varicocele is a common cause of male infertility.
- Scintigraphy offers a method to assess scrotal hemodynamics.
- Understanding hemodynamic patterns can optimize treatment strategies.
Purpose of the Study:
- To correlate scintigraphically assessed hemodynamics of left testicular varicoceles with spermatogenesis.
- To evaluate the impact of varicocelectomy on these hemodynamic patterns and fertility outcomes.
Main Methods:
- Comparison of time-activity curves (TAC) of the left hemiscrotum with femoral artery and muscle.
- Classification of scrotal TAC into three types (TAC-1, TAC-2, TAC-3) based on blood flow patterns.
- Analysis of testicular biopsy and semen parameters before and after varicocelectomy in relation to TAC types.
Main Results:
- Sixty patients were categorized into TAC-1 (17), TAC-2 (13), and TAC-3 (30) groups.
- Post-varicocelectomy, left scrotal TAC normalized to a pattern similar to the left femoral muscle.
- Spermatogenesis showed the most deterioration in TAC-2 patients; improved total motile sperm counts were observed in 58.8% (TAC-1), 69.2% (TAC-2), and 26.7% (TAC-3) post-surgery.
Conclusions:
- Patients with TAC-1 and TAC-2 hemodynamic patterns are better candidates for varicocelectomy.
- Hemodynamic differences in internal spermatic veins and pampiniform plexus may exist between TAC-3 and other groups.
Objective:
Scintigraphically assessed hemodynamics of left testicular varicoceles were correlated with spermatogenesis and the effect of varicocelectomy.
Methods:
Comparison of the time-activity curve (TAC) of the left hemiscrotum with those of the femoral artery and femoral muscle identified three types of scrotal TAC:TAC-1 peaked as rapidly as in the femoral artery; TAC-3, as slowly as in femoral muscle, and TAC-2, intermediate between these. Comparison of TAC of the left hemiscrotum before and after varicocelectomy was done. Testicular biopsy specimens and the effect of varicocelectomy on semen analyses were compared between the types of TAC.
Results:
60 patients were divided into 3 groups: 17 in TAC-1; 13 in TAC-2, and 30 in TAC-3. The TAC of the left scrotum showed the same TAC pattern as the left femoral muscle in each patient after varicocelectomy. Spermatogenesis deteriorated most in biopsy specimens from TAC-2 patients. Semen analysis showed improved total motile sperm counts in 58.8, 69.2 and 26.7% of TAC-1, TAC-2, and TAC-3 patients, respectively.
Conclusions:
TAC-1 and TAC-2 patients were better candidates for varicocelectomy than TAC-3 patients. The hemodynamics of the internal spermatic veins and pampiniform plexus in TAC-3 patients might be different from those in TAC-1 and TAC-2 patients.