Peak retrograde flow a potential objective management tool to identify young adults with varicocele ‘at risk’ for a high sperm DNA fragmentation

  • G. De Win
    Correspondence
    Correspondence to: G. De Win, Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
    Affiliations
    Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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  • D. De Neubourg
    Affiliations
    Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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  • S. De Wachter
    Affiliations
    Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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  • D. Vaganée
    Affiliations
    Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
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  • U. Punjabi
    Affiliations
    Centre for Reproductive Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium

    Department of Reproductive Medicine, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
    Search for articles by this author
Published:September 22, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.09.018

      Summary

      Introduction

      Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who would benefit most from surgery. Since conventional semen parameters, have been limited in their ability to evaluate the negative effects of varicocele on fertility, specialized laboratory tests have emerged.

      Objective

      To identify clinical and ultrasound parameters (including PRF) which would negatively influence standard and functional semen variables in young adults with a varicocele.

      Design

      Prospective, cross-sectional observational study.

      Setting

      Antwerp University Hospital, Belgium.

      Patient(s)

      Young volunteers between 16 and 26 years, Tanner 5, were recruited.

      Intervention(s)

      Every participant had a scrotal ultrasound to calculate testicular volumes. If a varicocele was present, the grade, vein diameter, peak retrograde flow (PRF) in supine position and spontaneous reflux in standing position were measured. All participants provided a semen sample. Standard semen parameters were analyzed and sperm DNA fragmentation.

      Main outcome measure(s)

      Of all clinical and ultrasound parameters tested, PRF was an objective tool identifying young adults with a varicocele. PRF was highlighted by the prevalence of SDF, both in the total and vital fractions of the spermatozoa, providing opportunities to manage such ‘at-risk’ adolescents/young adults.

      Result(s)

      Total SDF was significantly increased in grade 3 varicocele compared to grade 1 and 2 but no significant difference with vital SDF or standard descriptive semen parameters was seen. Total and vital SDF on the other hand were significantly increased when PRF was above 38.4 cm/s. Standard semen analysis showed no difference with PRF as an independent predictor. Testicular atrophy index, varicocele vein diameter and spontaneous reflux revealed no significant differences in both the descriptive and functional semen variables.

      Discussion

      Descriptive semen parameters showed no significant difference between the non-varicocele controls and the varicocele group with low and high PRF. Increased PRF negatively influenced sperm quality via increased DNA fragmentation both in the total as in the vital fractions of the semen.

      Conclusion(s)

      Of all clinical and ultrasound parameters tested, PRF was an objective non-invasive tool to identify varicocele patients at risk for a high SDF.

      Keywords

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