Can the testicular parenchyma fibrosis be a predictor of testicular failure in the patients with varicocele?
Diagnostic imaging plays a fundamental role in the diagnosis and staging of varicocele. In particular the European Association of Urology (EAU) recommends confirmation by color Doppler sonography after the diagnosis of varicocele is made by clinical examination. Color Doppler sonography was also be described like an useful tool for predicting the outcome of varicocelectomy (1). In the last years diffusion-weighted MRI of the testes was evaluated in order to detect fibrosis of the testicular parenchyma in the patients whose underwent varicocelectomy (2). The aim of this paper was to describe our preliminary experience in the use of the MRI for the patients with varicocele.
Materials and Methods
From January 2016 to July 2016 we recruited 10 consecutive patients with varicocele and 10 healthy control volunteers. The diagnosis of varicocele was confirmed by a physical examination and by color Doppler sonography. All patients exhibited unilateral varicocele and oligoastenozoospermia . All previous testicular pathologies (infections, trauma, torsion, tumor) were excluded in all patients. Infertile man using medications were also excluded. All patients and control volunteers underwent an MRI examination using a 1.5 T unit. The mean±DS ADC (Apparent Diffusion Coefficient) values were classified for testicles with varicocele (Group 1), testicles contralateral to varicocele (Group 2) and testicles of the control volunteers (Group 3). 5 out of 10 patient in the group 1 had a grade 2 of varicocele (Group 1a) and 5 out of 10 patient had a grade 3 or higher of varicocele (Group 1b). 4 out of 10 patient in the group 1 significantly improved their seminal parameters at six months follow-up without any medical therapy (group 1c) and 6 out of 10 patient in the group 1 did not significantly improved their seminal parameters (group 1d).
There were no differences in the demographics and baseline characteristics between the two groups. The mean±DS ADC was 940.25±27.26 in the Group 1, 955.46±29.2 in the Group 2 and 1109.52±31.50 in the Group 3. A statistically significant difference was observed between the Group 1 and the Group 3. Moreover, a statistically significant difference was also observed between the Group 2 and the Group 3. No differences were seen between the Group 1 and the Group 2 (p=0,2442)
The mean±DS ADC was 918,6±8,65 in the Group 1a and 953,2±29,14 in the Group 1b (p=0,0344).
The mean±DS ADC was 914,2±4,91in the Group 1c and 957,6±21,69 in the Group 1d (p=0,0024).
In this paper we confirmed that the mean ADC values significantly differed between patients with varicocele and healthy volunteer. Moreover also in the controlateral testis is possible to find signs of testiculare failure. The mean ADC also correlates with the grade of the varicocele and with the seminal parameters recovery at six months post-surgery. The decrease ADC values can be related to hypoxic and fibrotic change and the decrease ADC values in the contralateral testicles can be related to the heat stress or can be explained by hormonal and autoimmune factors. A limitation of this study is the small cohort of patients.
In conclusion, ADC values at MRI examination using a 1.5 T unit are a promising parameter in the detection of testicular fibrosis in patients with varicocele. It can be also used as a predictive parameter for determination of the degree of testicular damage and the ability to improve the seminal parameter after surgery.
1- Hussein AF- The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol. 2006 Nov;176(5):2141-5.
2- Karakas E, Karakas O, Cullu N, Badem OF, Boyacı FN, Gulum M, Cece H.Diffusion-weighted MRI of the testes in patients with varicocele: a preliminary study. AJR Am J Roentgenol. 2014 Feb;202(2):324-8.