Testicular ultrasound harmonic imaging contrast henanced is related to sperm count in patients with varicocele

Maurizio Carrino1, Luigi Pucci1, Ciro Acampora2, Clemente Meccariello1, Riccardo Riccio1, Paolo Fedelini1
  • 1 AORN A. Cardarelli - U.O.S. Andrologia Chirurgica (Napoli)
  • 2 AORN A. Cardarelli - U.O.C. Radiologia (Napoli)


The preoperative testicular morphology correlates significantly with the success of surgical correction of varicocele when you consider how unique endpoint improvement of semen parameters. It is useful to remember that even more complex is the correlation between the size of the varicocele and tubular damage. The evaluations of single-parameter correlation with the degree according to Sarteschi, duration of disease and age of onset were not significant. The use of harmonic imaging with contrast offers new perspectives for the evaluation of the damage to the peritubular microcirculation (ischaemic theory). The aim of our study was to evaluate the possible correlation between peritubular ischaemia and sperm density.

Methods and results

In the period January 2011- December 2012 were enrolled 136 patients with clinical varicocele (94 with oligospermia , 42 with normal semen analysis according to WHO 2010 ). After history and physical examination were subjected to endocrine and bacteriologic evaluation, and almost two seminal analyses. We excluded 13 patients (6 for inflammatory dyspermia, 15 serious dyspermia and 1 oligo-asteno-terato spermia with borderline FSH ). The remaining 105 patients were subjected to ultasound harmonic imaging with contrast medium from a single operator. It was calcolated the time of first display arteriolar contrast ( wash-in ) , the peak arterial, the venous impregnation time ( wash-out ) and the mean transit time .
All the parameters of harmonic imaging were higher in patients with varicocele regardless of the coexistence of dyspermia and surprisingly there is no linear correlation with the clinical grade. Was instead evident negative correlation between sperm concentration and mean transit time of the left ( R = 0.29) . In a multivariate model the mean transit time was the only indipendent parameter predictive of oligospermia (< 0.05). In fact superior values to 38 seconds gives strong prevision of oligospermia in patients with left varicocele with 78% sensitivity , 58 % specificity .


Our results confirm the impact of peritubular ischaemia in patients with varicocele related dyspermia. The indication for surgical treatment, however, can not currently be changed by contrast imaging mainly because of cost and not easy availability of radiolgists trained in this procedure and should not therefore be included in routine diagnostics. It's in our view useful in controversial situations as in the case in which we were faced to a borderline dyspermia, puberty medium degree varicocele or advanced age, in which the demonstration of the peritubular damage can modify the therapeutic strategy and in which the management is controversial and the procedure may seem almost an overtreatment.