Radioisotope angiography in diagnosis of varicocele

A varicocele, the most common surgically correctable cause of subfertility in men, is a manifestation of abnormal retrograde venous blood flow through the internal spermatic vein into the peritesticular pampiniform plexus. Methods of diagnosing the varicocele, including careful physical examination using a Valsalva maneuver as well as a Doppler stethoscope, remain somewhat subjective. Venography, while a reliable and objective technique, is invasive and not without morbidity. In the present study, 16 patients with clinically detectable varicoceles of various sizes were studied using a testicular radioisotope angiogram developed in our laboratory. Following the injection of 15 mg. of stannous pyrophosphate which results in tagging of the circulating red cell pool, 20 mCi. of 99m-technetium were administered in an intravenous bolus injection. The isotope binds to the pyrophosphate thus tagging the red blood cells and creating a blood-pooling agent with a relatively short half-life (six hours). Perfusion studies as well as static views of the scrotal contents, both in the supine and erect position, with and without Valsalva maneuver, were obtained using a gamma camera. The activity in each hemiscrotum then was quantitated using a digital computer. It is proposed that quantitation of this differential blood pool will make the identification of even subclinical varicoceles a potentially objective determination.