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Can the testicular parenchyma fibrosis be a predictor of testicular failure in the patients with varicocele?

Carrino, M1Pucci, L1; Chiancone, F1; Fusco, F2; Mirone, V2; Fedelini, P1

1: A.O.R.N. A. Cardarelli, Dept. of Andrology, Naples, Italy; 2: Department of Neuroscience, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples, Italy

Objectives: In the last years diffusion-weighted MRI (magnetic resonance imaging) of the testes was evaluated in order to detect fibrosis of the testicular parenchyma in the patients whose underwent varicocelectomy. The aim of this study was to describe our preliminary experience in the use of the MRI for the patients   with varicocele.

Material and Methods: From June 2016 to December 2016 we recruited 10 consecutive patients with varicocele and 10 healthy   control volunteers. All patients exhibited unilateral varicocele and oligoastenozoospermia. 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).

Results: 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).

Conclusions: In this study we demonstrate 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.


Work supported by industry: no.

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