Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Hemodynamic evaluation of varicocele: The role of scrotal scintigraphy and Doppler ultrasonography in the prediction of postoperative seminal improvement



The aim of this study was to evaluate the hemodynamics of varicocele using Doppler ultrasonography and scrotal scintigraphy, and to compare the value of these two methods in the prediction of seminal improvement after varicocelectomy.

Materials and Methods

A total of 40 men with left sided varicocele presented for surgery because of infertility of at least one year in duration. Preoperative and postoperative sperm counts and per cent motility were obtained. Dynamic scrotal scintigraphy and Doppler ultrasonography were performed in all patients. Three perfusion patterns according to the time-activity curves (TAC) generated from scrotal perfusion images were defined. Type 1 : radioactivity shows faster accumulation and maintenance of a higher level on the left side than on the right side. Type 2: time-activity curve rises gradually to a higher level on the left than on the right. Type 3: time-activity curve increases symmetrically and slowly on both sides. The relationship between preoperative TAC patterns and postoperative seminal findings, and preoperative Doppler grades and postoperative seminal findings were investigated.


Improvement in total motile sperm counts was not statistically significant (37.8% ± 3.2% versus 45.2% ± 8.5%) (p = 0.751). Following varicocelectomy, sperm concentration (million sperm per ml) increased from 16.9 ± 3.3 to 26.6 ± 8.6 (p = 0.015). According to the Doppler examinations, postoperative improvement in sperm concentration was demonstrated in patients with grade 1 varicocele (66%). Scintigraphic evaluation showed improvement in patients showing TAC-2 and TAC-3 patterns (63%).


Local hemodynamics of varicoceles demonstrated by scintigraphy and Doppler seemed to be different. Grade 1, TAC-2 and TAC-3 patients may be better candidates for varicocelectomy. Scintigraphy and Doppler ultrasonography showed similar success rates in the prediction of improvement following varicocelectomy in the present study.

This is a preview of subscription content, log in to check access.


  1. 1.

    Johnson DE, Pohl DR, Rivera-Correa H. Varicocele: an innocuous condition?South Med J 1970; 63: 34–36.

  2. 2.

    Dubin L, Amelar RD. Varicocele.Urol Clin North Am 1978; 5: 563–572.

  3. 3.

    Dubin L, Amelar RD. Etiologic factors in 1294 consecutive cases of male infertility.Fertil Steril 1971; 22: 469–474.

  4. 4.

    Matkov TG, Zenni M, Sandlow J, Levine LA. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy.Fertil Steril 2001; 75: 63–68.

  5. 5.

    Nagler HM, Luntz RK, Martinis FG. Varicocele.Infertility in the Male. Lipshultz LI, Howards SS, eds. St. Louis; Mosby, 1997: 336–368.

  6. 6.

    Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy. A critical analysis.Urol Clin North Am 1994; 21: 517–529.

  7. 7.

    Tinga DJ, Jager S, Bruijmen CL, Kremer J, Mensink HJ. Factors related to semen improvement and fertility after varicocele operation.Fertil Steril 1984; 41: 404–410.

  8. 8.

    Steckel J, Dicker AP, Goldstein MJ. Relationship between varicocele size and response to varicocelectomy.J Urol 1993; 149: 769–771.

  9. 9.

    Jungwirth A, Gögiis C, Hauser W, Gomahr A, Schmeller N, Aulitzky W, et al. Clinical outcome of microsurgical subinguinal varicocelectomy in infertile men.Andrologia 2001; 33: 71–74.

  10. 10.

    Harrison RM, Lewis RW, Roberts JA. Testicular blood flow and fluid dynamics in monkeys with surgically induced varicoceles.J Androl 1983; 4: 256–260.

  11. 11.

    Comhaire F, Simons M, Kunnen M, Vermeulen L. Testicular arterial perfusion in varicocele: the role of rapid sequence scintigraphy with technetium in varicocele evaluation.J Urol 1983; 130: 923–926.

  12. 12.

    Minayoshi K, Okada H, Fujisawa M, Yamasaki K, Kamidono S. Hemodynamic evaluation of left testicular varicocele by scrotal scintigraphy.Eur Urol 2001; 39: 30–35.

  13. 13.

    Fuse H, Nozaki T, Ohta S, Seto H. Sequential scrotal scintigraphy for the study of varicocele.Int Urol Neph 1999;31:511–517.

  14. 14.

    Baert AL. Ultrasound-ECR Syllabus, Springer, Vienna, 2002.

  15. 15.

    WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, 4th ed. World Health Organ. Cambridge, United Kingdom; Cambridge University press, 1998.

  16. 16.

    Pryor JL, Howards SS. Varicocele.Urol Clin North Am 1987;14:499–513.

  17. 17.

    Madgar I, Weissenberg R, Lunenefeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men.Fertil Steril 1995; 63: 120–124.

  18. 18.

    Marmar JL, Kim Y. Subinguinal microsurgical varico-celectomy: a technical critique and statistical analysis of semen and pregnancy data.J Urol 1994; 1127–1132.

  19. 19.

    Ito H, Kotake T, Hamano M, Yanagi S. Results obtained from microsurgical therapy of varicocele.Urol Int 1993; 51:225–227.

  20. 20.

    Greenberg SH, Lipshultz L, Wein AJ. Experience with 425 subfertile male patients.J Urol 1970; 119: 507–510.

  21. 21.

    Jarow JP, Ogle SR, Eskew LA. Seminal improvement following repair of ultrasound detected subclinical varico-celes.J Urol 1996; 155: 1287–1290.

  22. 22.

    Seftel AD, Rutchik SD, Chen H, Stovsky M, Goldfarb J, Desai N. Effects of subinguinal varicocele ligation on sperm concentration, motility and Kruger morphology.J Urol 1997; 158: 1800–1803.

  23. 23.

    Vasquez-Levin MH, Friedmann P, Goldberg SI, Medley NE, Nagler HM. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to therapeutic varicocelectomy.J Urol 1997; 158: 1804–1807.

  24. 24.

    Hargreave TB. Varicocele: overview and commentary on the results of the World Health Organisation varicocele trial. In:Current advances in Andrology. Waites GMH, Frick J, Baker GWH, Monduzzi, eds. Italy; Bologna, 1997: 31–43.

  25. 25.

    Takahara M, Ichikawa T, Shiseki Y, Nakamura T, Shimazaki J Relationship between grade of varicocele and the response to varicocelectomy.Int J Urol 1996; 3: 282–285.

  26. 26.

    Iwamoto T, Hirokawa M. Clinical study of infertile males with varicocele showing no typical radionuclide blood pooling on dynamic image of scrotal scintigraphy.Urology 1991;37:562–567.

  27. 27.

    Mali WP, Oei HY, Arndt JW, Kremer J, Coolsaet BL, Shuur K. Hemodynamics of the varicocele. Part II: correlation among the results of renacaval pressure measurement, varicocele scintigraphy and phlebography.J Urol 1986; 135: 489–493.

  28. 28.

    Marks JL, McMahon R, Lipshultz LI. Predictive parameters of successful varicocele repair.J Urol 1986; 136:609–612.

  29. 29.

    Glezerman M, Rakowszczyk M, Lunenfeld B, Beer R, Goldman B. Varicocele in Oligospermic patients: patho-physiology and results after ligation and division of the internal spermatic vein.J Urol 1976; 115: 562–565.

  30. 30.

    Dubin L, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele.Fertil Steril 1970; 21: 606–609.

Download references

Author information

Correspondence to Hulya Ortapamuk or Umit Yener Tekdogan or Seniha Naldoken or Suleyman Bulut or Ali Atan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ortapamuk, H., Tekdogan, U.Y., Naldoken, S. et al. Hemodynamic evaluation of varicocele: The role of scrotal scintigraphy and Doppler ultrasonography in the prediction of postoperative seminal improvement. Ann Nucl Med 19, 529–534 (2005).

Download citation

Key words

  • varicocele
  • scrotal scintigraphy
  • Doppler ultrasonography
  • semen
  • infertility