Hemodynamic evaluation of left testicular varicocele by scrotal scintigraphy.

OBJECTIVE

Scintigraphically assessed hemodynamics of left testicular varicoceles were correlated with spermatogenesis and the effect of varicocelectomy.

METHODS

Comparison of the time-activity curve (TAC) of the left hemiscrotum with those of the femoral artery and femoral muscle identified three types of scrotal TAC:TAC-1 peaked as rapidly as in the femoral artery; TAC-3, as slowly as in femoral muscle, and TAC-2, intermediate between these. Comparison of TAC of the left hemiscrotum before and after varicocelectomy was done. Testicular biopsy specimens and the effect of varicocelectomy on semen analyses were compared between the types of TAC.

RESULTS

60 patients were divided into 3 groups: 17 in TAC-1; 13 in TAC-2, and 30 in TAC-3. The TAC of the left scrotum showed the same TAC pattern as the left femoral muscle in each patient after varicocelectomy. Spermatogenesis deteriorated most in biopsy specimens from TAC-2 patients. Semen analysis showed improved total motile sperm counts in 58.8, 69.2 and 26.7% of TAC-1, TAC-2, and TAC-3 patients, respectively.

CONCLUSIONS

TAC-1 and TAC-2 patients were better candidates for varicocelectomy than TAC-3 patients. The hemodynamics of the internal spermatic veins and pampiniform plexus in TAC-3 patients might be different from those in TAC-1 and TAC-2 patients.