Abstract:
Varicocele is known to be associated with infertility and sperm disorders. The exact
mechanism behind these mal effects is yet not clear, especially the relationship of testicular
blood flow and semen quality parameters. Objective of the study was to evaluate testicular
blood flow pattern and spermatic cord microanatomy of infertile individuals with varicocele
and to find their correlation/association with semen quality. Sixty consecutive patients between
20–45 years age, diagnosed with infertility and varicocele, undergoing microsurgical
varicocelectomy at Fatima Memorial Hospital Lahore, were included in the study. Semen
quality parameters and scrotal color Doppler ultrasonography (CDUS) were recorded
preoperatively. During surgery, microanatomy of the spermatic cord was observed. The
outcomes of semen analysis were sperm count, motility and morphology. The testicular blood
flow was determined as peak systolic velocity (PSV) and resistive index (RI) of sub capsular
artery and intra parenchymal artery of the testes by scrotal CDUS. During microsurgery,
anatomy of varicocele veins, testicular artery, arterio-venous micro communications,
lymphatics and their arrangement was recorded. Result revealed that of 60 patients, mean
sperm count, progressive motility and morphology were 29.6±24.26 million/mL,
16.47±14.53% and 5.18±5.47% respectively. The mean varicocele diameters were 3.26±0.85
and 3.72 ± 1.10 mm at lying position and at standing posture with valsalva maneuver
respectively. No significant correlation was found between semen quality parameters and
varicocele vein diameter. Similarly there was no correlation between the sperm count and
testicular blood flow parameters. A negative correlation was found between progressive
