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[Echo-color doppler in the topographic study of varicocele]
A Callea1, B Berardi, V Dilorenzo
1Divisione di Urologia, Policlinico, Bari.
Insights
Echo color Doppler imaging accurately distinguishes spermatic from cremasteric venous reflux in varicoceles. This precise diagnosis guides rational surgical approaches, reducing patient morbidity and preventing treatment failures.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Urology
Background:
- Varicocele, a common cause of male infertility, involves abnormal venous blood flow in the scrotum.
- Distinguishing between spermatic and cremasteric venous reflux is crucial for effective surgical management.
- Traditional diagnostic methods may not always clearly differentiate these reflux types, potentially leading to suboptimal surgical outcomes.
Purpose of the Study:
- To evaluate the utility of echo color Doppler in differentiating spermatic from cremasteric venous reflux.
- To assess the impact of this distinction on surgical strategy and patient morbidity.
- To correlate Doppler findings with surgical outcomes in infertile patients with varicocele.
Main Methods:
- Twenty infertile patients with varicoceles underwent echo color Doppler examination of testicular vessels.
- Venous reflux was assessed in spermatic and cremasteric veins at rest and during the Valsalva maneuver.
- Surgical interventions were tailored based on Doppler findings: retroperitoneal for spermatic reflux, inguinal for cremasteric reflux.
Main Results:
- Echo color Doppler successfully differentiated spermatic from cremasteric reflux in all cases.
- Spermatic vein reflux was identified in 80% of patients, cremasteric in 5%, and both in 15%.
- Surgical treatment guided by Doppler findings resulted in successful reflux elimination, confirmed by follow-up Doppler checks.
Conclusions:
- Echo color Doppler is a highly accurate diagnostic tool for characterizing venous reflux in varicoceles.
- This imaging modality enables precise surgical planning, reserving specific approaches for specific reflux types.
- Accurate diagnosis and tailored surgery minimize recurrence and reduce surgical morbidity associated with varicocele treatment.
Abstract:
The echo color doppler allows an easy topographical distinction of the spermatic reflux (in front of the deferens) from cremasteric one (back to the deferens). This distinction consents a rational surgical choice, the selective interruption of the refluent vein and a less morbidity due to the surgical intervention. We evaluated 20 infertile patients (mean age 23 years) with echo color doppler testicular vessels (B & K 7.5 Mhz transducer). Seven varicoceles were clinically evident, 13 varicoceles were subclinic. After locating the deferens, we evaluated the venous reflux in the spermatic and cremasteric veins. The evaluation has been performed at rest and during Valsava maneuver. We used, in the correction of the anterior (spermatic) reflux, a retroperitoneal surgical access, while in the back (cremasteric) reflux isolated or combined, we performed middle or under inguinal access. The mean follow up has been of 4 months. In all cases the veins with reflux have been easily characterized. In 16 patients (80%) the spermatic vein was concerned; in an isolated case (5%) the reflux concerned only the cremasteric vein, in 3 patients (15%), with clinical varicocele, the reflux was present in both the veins (Coolsaet III type). In the 16 spermatic varicoceles, treated with retroperitoneal access (Palomo), the echo color doppler check demonstrated the absence of venous reflux. In the 4 varicoceles regarding the isolated or associate cremasteric vein treated with middle or under inguinal access, the existence of extra funicular varix was highlighted and after surgery the echo color doppler check was negative. In our few cases the echo color doppler diagnosis demonstrated a total correspondence with the surgical finds and with the doppler follow up. This diagnostic approach allows to reserve the retroperitoneal surgery to the spermatic pure reflux avoiding the false relapses due to the persistence of an undiagnosed cremasteric reflux. The middle or under inguinal approaches, generally loaded from a greatest morbidity, could be only employed in presence of an isolated or combined cremasteric reflux.