Color Doppler ultrasound in identifying the causes of varicocele

Authors

B.M. Rakhmatullaev - Director of the clinic "Andrologist and Me"

A.A. Gaibullaev

I.S. Bulgarian

Tashkent

Varicocele is diagnosed in 8-20% of young men. The existing connection between fertility and varicose veins of the spermatic cord makes varicocele a social problem.

To determine the causes of varicocele, transfemoral venography with catheterization of the renal and testicular veins is currently widely recommended. This method is invasive, it is technically complex and has a number of complications.

In recent years, color Doppler ultrasound has been used to diagnose occlusive vascular lesions.

In the urological clinic of TashIUV from 1999 to 2000, 98 patients, aged 13 to 35 years, underwent color Doppler ultrasound. It was produced on a device from Siemens (Sonlain Versa) 1996.

Color Doppler ultrasound allows you to identify types of venous blood flow. According to the classification proposed by Coolsaet, several types of varicocele are distinguished according to hemodynamic disorders.

1. Type. Renospermatic reflux due to aortomesenteric “tweezers” or valvular insufficiency of the internal testicular vein.

2. Type. Ileospermatic reflux.

3.Mixed type.

Trombetta (1993) proposed a method for indirectly identifying the source of blood discharge in the pharniform plexus. E.B. Mazo et al. (1999) proposed their own modification of this technique. We used the Trombetta technique modified by E.B. Maso for identifying hemodynamic types of varicocele.

1. Renospermatic type - absence of venous reflux.

2. Ileospermatic reflux - the rate of venous reflux is equal to the initial one.

3. Combination of ileospermatic and renospermatic venous reflux - the rate is lower than the initial one.

Comparison of the diameter of the veins against the background of compression and after its cessation reveals differential signs of hemodynamic types of varicocele.

1. Renospermatic reflux - an increase in diameter by 2 times.

2. Ileospermatic reflux - in orthostasis with compression, the diameter of the veins increases by 100%; after eliminating the compression, there is no increase in diameter.

3. Renospermatic and ileospermatic refluxes - with orthostasis and compression, a slight increase in the veins is not more than half, after eliminating the compression, the diameter increases by 2 times.

Based on changes in color Doppler ultrasound, all patients were divided into 3 groups. Group 1 included 79 (80.6%) patients; the average diameter of the veins with clinostasis and orthostasis without compression was 0.32 and 0.6 cm (increase in diameter by an average of 91.5%). In 31 patients from this group, sperm was examined and in 26 of them there were changes in the seminal fluid. They were expressed in qualitative and quantitative indicators.

The second group included 12 patients (12.5%), the average diameter of the veins in clinostasis was 0.33 cm, in orthostasis 0.66 cm. Consequently, the increase in diameter was 100%. 6 patients were examined and in 1 (8.3%) sperm was changed.

The third group included 7 (7.14%) patients, the average diameter in clinostasis was 0.25 and in orthostasis 0.6. The increase in diameter was (140%); changes in sperm were detected in 4 patients (57.1%). Among all examined patients, 4 had relapses. Of these, 1 has renospermatic reflux, 2 have ileospermatic reflux, and 1 has mixed reflux.

The examination results showed that color Doppler ultrasound, a non-invasive method for determining the hemodynamic type of varicocele.

In the presence of renospermatic type of reflux, ligation of the testicular vein naturally gives a good result. We agree with the opinion of E.B. It is clear that in case of ileospermatic reflux, Ivanissevich’s operation will be ineffective, it is advisable to perform a testiculoepigastric anastomosis. In type III, if renospermatic reflux prevails, then the Ivanissevich operation will be effective. In the postoperative period, control sperm tests should be performed. Therefore, these patients should be under dynamic observation.

Thus, color Doppler ultrasound for varicocele allows you to accurately diagnose varicocele, the stage of the pathological process, and assess the hemodynamic type of varicocele, which allows you to choose the right treatment method.