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Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach
Published on: November 22, 2024
Echocardiographic and hemodynamic changes in patients with high-grade varicocele
Batuhan Ergani1, Azmi Eyiol2, Mustafa Karabiçak3
1Department of Urology, Beyhekim Training and Research Hospital, Konya, Turkey.
Insights
High-grade varicocele (abnormal veins in the scrotum) is linked to increased cardiovascular and hemodynamic risks. Men with symptomatic varicocele and poor semen quality require cardiac evaluation.
Area of Science:
- Urology
- Cardiology
- Andrology
Background:
- Varicocele, characterized by abnormal tortuosity and dilatation of pampiniform plexus veins, is associated with testicular dysfunction and may be a systemic disease.
- Existing research suggests varicocele might be linked to cardiovascular abnormalities, necessitating further investigation into associated hemodynamic pathologies.
Purpose of the Study:
- To investigate the potential association between high-grade left varicocele and cardiovascular and hemodynamic abnormalities.
- To evaluate cardiac parameters in varicocele patients compared to a healthy control group.
Main Methods:
- A prospective, multicentric study involving 103 patients with high-grade left varicocele and 133 healthy controls.
- Participants underwent semen analysis, total testosterone determination, scrotal Doppler ultrasonography, blood pressure measurement, and echocardiographic evaluation by blinded cardiologists.
Main Results:
- Varicocele patients exhibited significantly higher diastolic blood pressure, left ventricular dimensions, ejection fraction, and pulmonary arterial pressure, along with altered aortic distensibility compared to controls.
- Lower interventricular septum wall thickness and aortic stiffness were observed in varicocele patients.
- Aortic distensibility was significantly lower in the non-normozoospermic group compared to the normozoospermic group.
Conclusions:
- Symptomatic patients with high-grade varicocele have an elevated risk of cardiovascular and hemodynamic disease.
- Cardiovascular and hemodynamic evaluation is recommended for men with high-grade symptomatic varicocele and impaired semen analysis, irrespective of spermatic vein diameter.
Abstract:
Varicocele is abnormal tortuosity and dilatation of the pampiniform plexus veins within the spermatic cord. Varicocele is associated with testicular atrophy, hypogonadism, impaired semen analysis values, or decreased testosterone production. Varicocele is a progressive disease and should be treated because it may be a systemic disease that can be associated with cardiovascular abnormalities. We hypothesize in this study that cardiovascular and hemodynamic pathologies may occur in varicocele patients. In this prospective, multicentric, multidisciplinary study, patients diagnosed with high-grade left varicocele in the urology clinic underwent semen analysis, total testosterone determination, and scrotal Doppler ultrasonography. In addition, blood pressure measurement and echocardiographic evaluation were performed by blinded cardiologists in both the varicocele patients and the healthy control group. The study was carried out with 103 varicocele patients and 133 healthy individuals who formed the control group. Diastolic blood pressure (P = 0.016), left ventricular end diastolic (P < 0.001) and systolic diameter (P < 0.001), ejection fraction (P < 0.001), pulmonary arterial pressure (P < 0.001), and aortic distensibility (P < 0.001) values were significantly higher in varicocele patients compared with controls; interventricular septum wall thickness (P = 0.022), aortic systolic (P < 0.001) and diastolic diameter (P < 0.001), aortic systolic (P < 0.001) and diastolic diameter index (P < 0.001), and aortic stiffness index (P < 0.001) values were significantly lower in varicocele patients. The mean aortic distensibility of non-normozoospermic group was lower than that of normozoospermic group (P = 0.041). There was no statistically significant relationship between thickest vein diameter in spermatic cord and cardiological parameters. This study showed that symptomatic patients with high-grade varicocele had a higher risk of cardiovascular and hemodynamic disease. We recommend that men with high-grade symptomatic varicocele with impaired semen analysis undergo cardiovascular and hemodynamic evaluation regardless of their spermatic vein diameter.
