Hemodynamic Patterns on Contrast-Enhanced Ultrasound Predict Semen Improvement After Varicocelectomy: A Novel Nomogram.

RATIONALE AND

OBJECTIVES

Contrast-enhanced ultrasound (CEUS) is an effective method for assessing varicocele (VC) hemodynamics; however, its value in predicting improvements in semen parameters after varicocelectomy remains unclear. This study investigated whether CEUS-based hemodynamic patterns could predict surgical outcomes and developed and validated a novel predictive model.

MATERIALS AND

METHODS

In this prospective cohort study, 187 patients with VC undergoing microscopic varicocelectomy were included. A total of 23 clinical, grayscale ultrasound, and CEUS-based hemodynamic parameters were collected. The primary outcome was semen parameter improvement (≥25% increase in total motile sperm count) six months postoperatively. Elastic net regression (ENR) selected key predictors, which were then included in a multivariate logistic regression model. The resulting nomogram's performance was evaluated using receiver operating characteristic curves, calibration, and decision curve analysis, and was internally validated using 1000 bootstrap resamples.

RESULTS

A total of 118 patients achieved post-operative semen parameter improvement. From 23 candidate variables, ENR identified three independent predictors as follows: left and right CEUS hemodynamic patterns and follicle-stimulating hormone. The nomogram demonstrated excellent discrimination, with an area under the curve of 0.822 and good calibration (Hosmer-Lemeshow test, P = 0.405). Decision curve analysis confirmed the clinical utility of the model across a wide range of risk thresholds.

CONCLUSION

CEUS-based pampiniform plexus hemodynamic patterns are independent predictors of post-operative semen parameter improvement in patients with VC. We successfully developed and validated a novel predictive nomogram. This study provides an effective, non-invasive tool for surgical decision-making and expands the clinical application of CEUS.