الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Varicocele is an abnormal pathological tortuosity and dilatation of the veins of the pampiniform plexus. Clinical varicocele is defined as the presence of distension of the intrascrotal veins of the pampiniform plexus, which is either a visible bulging of the scrotal skin, or easily palpable, or palpable during Valsalva maneuver only. Subclinical varicocele cannot be palpated, but is detected by means of technical investigations. In general population, the overall incidence of varicocele is 10% to 15%. In addition, approximately half the males with primary infertility suffer from varicocele. Varicocele have traditionally been reported on the left side (77-92%), with isolated right-sided (1%) and bilateral varicoceles (10%) reported much less commonly.
Color Doppler ultrasound (CDUS) is a simple, inexpensive, noninvasive, objective method that may be used to investigate the scrotum not only for the presence of varicocele but also for other pathologic processes and the documentation of testicular size. Sensitivities are reportedly as high as 97%, with specificities around 94%. In addition to identifying retrograde flow, ultrasonography sensitivity has also progressed to detecting scrotal varicosities that are too slight to be identified on physical examination (subclinical varicoceles).
The present study aimed at assessing the different vascular changes in patients with varicocele with and without infertility using CDUS imaging techniques. The study was conducted at the Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University on 30 varicocele patients randomly selected from the Andrology outpatient clinic of the Alexandria University Main Hospital. 10 healthy fertile age-matched male subjects were included as well to serve as a control group for the study.
Varicocele patients were divided into two main groups; ten fertile patients with varicocele constituted the first group and twenty infertile patients with varicocele constituted the second group. Following history taking, general medical examination and local examination with clinical assessment of the grade of varicocele, semen analysis and CDUS examination were conducted. Measurements obtained by CDUS examination included: testicular volume, testicular artery diameter, peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (Vm), resistance index (RI), pulsatility index (PI) and testicular artery blood flow (TABF).
The present study results showed a repeated pattern among patients when comparing semen parameters in between both fertile and infertile varicoceles patients and again when comparing varicocele patients to control subjects. This pattern demonstrated the worst parameters values associated with infertile patients suffering from varicocele. Varicocele patients who are fertile showed better overall semen parameters, however, obviously not on bar with healthy subjects. This pattern was similarly recurrent with all semen parameters investigated in the current study; including sperm motility, number of motile sperms, and the percentage of abnormal forms present. All the differences mentioned above attained statistical significance level, with some comparisons of semen parameters among the three groups attaining a strong statistically significant values.