STRATEGY OF ULTRASONOGRAPHIC FOLLOW-UP IN PATIENTS WITH VARICOCELE

Purpose: Reflux in pampiniform plexus (varicocele) occurs in 4–15% of adult patients. In our study we evaluated patients with inconclusive findings during primary examination or in the follow-up after laparoscopic surgery. Changes in sperm cell count after surgery in patients with „delayed“ diagnosis were also assessed.

Methods and Materials: Sixty seven patients with negative primary or the first follow-up exam after laparoscopic surgery were assessed in year 2004. Patients with positive clinical or ultrasound findings during the first visit or patients with other detectable cause of infertility were excluded. All patients underwent repeated sonographic evaluation with linear probe (12MHz) on ultrasound machine 2102 Hawk (BK Medical, Denmark) and sperm cell count was performed in every visit. Follow-up schedule included visits at 3, 6 and 12 months after the negative first examination.

Results: Eleven of thirty eight patients after negative primary evaluation had positive ultrasound examination during the follow-up. Seven and four patients had positive findings after 3 and 6 monhts, respectively. Remaining group of patients had negative finding without any change in sperm cell count. Four of twenty nine patients after surgery had positive finding at the first visit (after 3 months) with no persistence detected thereafter. Improvement in sperm cell count were assessed in 35% patients after successful surgery in group with „delayed“ varicocele diagnosis. This value is comparable with that of published results in immediate treatment (27–51%).

Conclusions: Indication of varicocele surgery requires unequivocal finding of reflux in pampiniform plexus. Based on the results of our study we recommend repated ultrasound evaluation in intervals of 3–6 months. This strategy allows to detect significant number of varicoceles. Role of varicocele treatment and sperm cell count changes in infertility remains unclear.