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Abstract

Volume 25, Issue 1 (January 2023) 25, 119–125; 10.4103/aja202248

Intense venous reflux, quantified by a new software to analyze presurgical ultrasound, is associated with unfavorable outcomes of microsurgical varicocelectomy

Kai You1, Bang-Bin Chen2, Peng Wang3, Ren-Ge Bu2, Xue-Wen Xu2

1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
2 Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China
3 Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China

Correspondence: Dr. XW Xu (xuxw@sj-hospital.org) or Dr. RG Bu (burg@sj-hospital.org)

26-Jul-2022

Abstract

The hemodynamic characteristics of venous reflux are associated with infertility in patients with varicocele; however, an effective method for quantifying the structural distribution of the reflux is lacking. This study aimed to predict surgical outcomes using a new software for venous reflux quantification. This was a retrospective cohort study of a consecutive series of 105 patients (age range: 22–44 years) between July 2017 and September 2019. Venous reflux of the varicocele was obtained using the Valsalva maneuver during scrotal Doppler ultrasonography before microsurgical varicocelectomy. Using this software, the colored reflux signals were segmented, and the gray scale of the color pixels representing the reflux velocity was comprehensively quantified into the mean reflux velocity of the green layer (MRVG) and the reflux velocity standard deviation of the green layer (RVSDG). Spontaneous pregnancy and changes from baseline in the semen parameters were assessed during a 12-month follow-up period. Data were analyzed using logistic regression analysis. An association of the high MRVG group with impaired progressive motility (odds ratio [OR] = 2.868, 95% confidence interval [CI]: 1.133–7.265) and impaired sperm concentration (OR = 2.943, 95% CI: 1.196–7.239) was found during multivariate analysis. High MRVG (OR = 2.680, 95% CI: 1.086–6.614) and high RVSDG (OR = 2.508, 95% CI: 1.030–6.111) were found to be independent predictors of failure to achieve pregnancy following microsurgical repair. In summary, intense venous reflux is an independent predictor of impaired progressive motility, sperm concentration, and pregnancy outcomes after microsurgical varicocelectomy.

Keywords: male infertility; ultrasonography; varicocele; venous insufficiency

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.