Page 1 Correlation between diameter of the pampiniform plexus in ...

Cor r el at i onbet weendi amet eroft hepampi ni f or m pl exusi n mi l l i met ermeasur edbyscr ot al Doppl erul t r asoundwi t ht he semi nal f l ui dpar amet er s Ass.pr of .Muhsi nAl qasar , M. B. Ch. B. F. R. C. SUr ol ogy *

Dr .AzzawiM.HadiM. B. Ch. B. F. I . B. M. SUr ol ogy . * * *Mosuluni v er si t yCol l egeofmedi ci neDepar t mentofsur ger y * * Ti kr i tuni v er si t yCol l egeofmedi ci neDepar t mentofsur ger y . Abst r act : Thest udyi nv ol v es158i nf er t i l eper sonssuf f er i ngf r om pr i mar yor secondar yi nf er t i l i t y .Thi sst udyai medt of i nedt hecor r el at i onbet ween di amet erofpampi ni f or m pl exus v ei ns measur ed by scr ot alDoppl er ul t r asoundwi t hpar amet er sofsemi nalf l ui danal y si s.Ther ewasnegat i v e cor r el at i on bet ween di amet erof pampi ni f or m pl exus v ei ns and t he concent r at i onofsper ms/ ml ,TPFS,sper m nor malmor phol ogy ,andt he act i v esper m mov ement ,whi l et hecor r el at i onwasposi t i v et heabnor mal sper ms,sl uggi shl ymov ed,andnonmot i l esper ms,t hi scor r el at i onswer e st at i st i cal l ysi gni f i cant . Accor di ngt ot hi sst udy ,t hesemi nalf l ui dpar amet er sar ecor r el at ed si gni f i cant l ywi t ht he di amet ert he sper mat i ccor dv ei nsmeasur ed by Doppl erul t r asound. Keywor d: semi nal f l ui d, cor r el at i on, v ar i cocel e.Doppl erul t r asound. I nt r oduct i on: Thedi l at i on and t or t uosi t yoft hepampi ni f or m pl exusknown as v ar i cocel e,whi ch pr esent i n 15% of t he mal e popul at i on,and i n 1 appr oxi mat el y40%ofmenpr esent i ngwi t hi nf er t i l i t y .

Test i cul art emper at ur eel ev at i onandv enousr ef l uxappeart opl ayan i mpor t antr ol ei nv ar i cocel e-i nducedt est i cul ardy sf unct i on,al t hought he exactpat hol ogyofv ar i cocel ei nduced damage i s noty etcompl et el y 3, 4 under st ood2, .

I nast udyof200menwi t hv ar i cocel e,ameansper m densi t yofl ess

6

t han20x10 sper m/ ml , andl owmot i l i t yi n90%ofpat i ent s, ashi f tofsper m shapef r om ov alt ot aper edandamor phous,andani ncr easei ni mmat ur e sper mf or ms5.Tot alpot ent i al l yf unct i onalsper mat ozoa( TPFS) ani ndexof t ot alcountmul t i pl i edbyper cent ageofact i v el ymot i l esper msmul t i pl i edby nor mal mor phol ogy -i saf f ect eddel et er i ousl ybyv ar i cocel e5. Var i cocel ewasconsi der edsi gni f i cantwheni thasadi amet erof3mm orgr eat er andr et r ogr adef l ow onDoppl erul t r asoundexami nat i on.The r ev er salf l ow char act er i st i cofv ar i cocel ei sconf i r medbypr ol ongedf l ow augment at i onwi t hi naf l owar eadepi ct edasr ev er si ng( i . e.changi ngcol or ) onr eal t i mei magi ng.Twoormor et or t uous,sonol ucentt ubul arst r uct ur e wi t h a cal i berof3mm ormor e ar e seen as t he hal l mar kf i ndi ng i n v ar i cocel es6. Col orDoppl eri magi nghasasensi t i v i t yof93% i ndet ect i onofof v enogr aphi cal l y di agnosed v ar i cocel es as compar ed wi t h 71% usi ng phy si calexami nat i on7.Ul t r asoundwasf oundt ohav ea95% sensi t i v i t yi n t hedet ect i onofsubcl i ni cal v ar i cocel es8. Theai m oft hest udyi st ocor r el at ebet weent hedi amet eroft he pampi ni f or m pl exusandsemi nal f l ui dpar amet er. Pat i ent sandmet hods: Thest udyi nv ol v es158pat i entwi t hhi st or yofpr i mar yorsecondar y i nf er t i l i t y(pat i entwi t h azoosper mi a wer eexcl uded) . Ref er r ed t ot he ur ol ogycl i ni ci nTi kr i tt eachi nghospi t alandpr i v at ecl i ni cbet weenJanuar y 2006t oJanuar y2008.Ev al uat i onofpat i ent si ncl udesdet ai l edhi st or y , phy si cal exami nat i on, semi nal f l ui danal y si s, andcol or edDoppl erst udy . Doppl erst udydonef ormeasur ementoft hedi amet eroft hev ei nsof t he pampi ni f or m pl exus ( wi t hv al sal v a maneuv er )i n mi l l i met er s. St at i st i calanal y si sandcor r el at i onbet weent her esul t sofDoppl erst udy and t he par amet er s ofsemi nalf l ui d par amet er s was done by usi ng Per son' sf or mul a.

Resul t s:

Pat i ent swer eaged bet ween2064 y ear sol d,93 ( 59%)oft hem suf f er edpr i mar yi nf er t i l i t yand65( 41%)hadsecondar yi nf er t i l i t ywi t ha dur at i onofi nf er t i l i t yr angedf r om 121y ear . Asseeni nt abl e( 1) ,t hedi amet erofbot hr i ghtandl ef tpampi ni f or m pl exusv ei nshadnegat i v ecor r el at i onwi t hconcent r at i on,t ot alpot ent i al l y f unct i oni ngsper ms,nor malmor phol ogyandact i v emot i l esper ms.These cor r el at i onwasst at i st i cal l ysi gni f i cant( p

˂ 0. 05) .I n cont r ast ,t he

cor r el at i onwasposi t i v ef orbot hr i ghtandl ef tpampi ni f or m pl exuswi t h abnor malmor phol ogy , sl uggi shl yandnonmot i l esper msThesecor r el at i on wasst at i st i cal l ysi gni f i cant(p˂ 0. 05) . Tot alpot ent i al l yf unct i oni ng sper ms,nor mal mor phol ogy ,and concent r at i onhadt hemor enegat i v ecor r el at i on( 0. 292, 0. 273, and0. 266 r espect i v el y )wi t ht hedi amet erofr i ghtpl exusv ei nst hant hecor r el at i on wi t hl ef tv ei ndi amet erwi t ht hesamev ar i abl est hesewer e( 0. 249, 0. 27, and 0. 226r espect i v el y ) . Non mot i l e and sl uggi shl y mot i l e sper ms had mor e posi t i v e cor r el at i onwi t hr i ght(0. 285,and0. 272r espect i v el y ) , t hanwi t ht hel ef t pampi ni f or m pl exusdi amet er (0. 22,and0. 269r espect i v el y ) .Theabnor mal mor phol ogyhadmor eposi t i v ecor r el at i onwi t ht hel ef tpl exust hant her i ght (0. 253, and0. 209r espect i v el y ) .

Di scussi on: I nt hi sst udywedi dn' tt aket hev ar i cocel easav ar i abl ei nt hest udy i nst eadweanal y zet hedi amet eroft hev ei nsandt hi si ncl udet henor mal andal l t hegr adeoft hev ar i cocel e. Ther ewasaweakbutsi gni f i cantnegat i v ecor r el at i on

wi t h

concent r at i on,t ot alpot ent i alact i v esper ms,hi ghl yact i v esper ms,and nor malmor phol ogy ,whi l et hecor r el at i onwasposi t i v e(t houghweakbut si gni f i cant )wi t ht hesl uggi shandnonmot i l esper msaswel lasabnor mal sper ms.Thesecor r el at i oncanbeexpl ai nedbyt hedel et er i ousef f ectoft he ( 5) di l at edv ei nsont hesper m count , mor phol ogyandact i v i t y .

Many st udi es had been publ i shed concer ni ng t he r ol e oft he v ar i cocel ei nmal ei nf er t i l i t y ,butt hei ssuei sst i l lcont r ov er si al .Theexact act i onmechani sm oft hev ar i cocel e' snegat i v eef f ectonsper mf unct i on ( 9)

andf er t i l i t yi snotr esol v ed .A st udyconduct edbyt heWHO i n1992 showedadecr easei nt est i cul arv ol ume,andt ot alsper m perej acul at e i n t hosewi t hv ar i cocel e,howev er ;t heot hersper m char act er i st i csofmot i l i t y and mor phol ogywer enoti nf l uenced byt hepr esenceofv ar i cocel e(10). Ot her st udy showed t hatal lsper m par amet er s wer ef ound t o be si gni f i cant l yl oweri npat i entwi t hv ar i cocel et hanf er t i l esubj ectwi t hout v ar i cocel e, butnocor r el at i onwasf oundwi t ht hev ar i cocel egr ade(11) Muchoft hehumandat ast udy i ngt heunder l y i ngmechani smsof v ar i cocel er el at edi nf er t i l i t yar eder i v edbymeasur i ngpar amet er si nmen wi t h and wi t hout v ar i cocel e and bet ween men pr e and post v ar i cocel ect omy .Howev er ,nonoft heseassoci at i onsi sabl ecl ear l yt o expl ai nt hev ar i abl eef f ectofv ar i cocel eordi r ect l yexpl ai nt hemechani sm( s) i nv ol v ed,especi al l yf or t he bi l at er al ef f ect . The et i ol ogy may be mul t i f act or i al ,and mayev en i ncl udeapr eexi st i ng genet i cdi sposi t i on, whi chmayaccountf orv ar i abl eef f ectofv ar i cocel eonsper mat ogenesi s andi nf er t i l i t yseeni nhuman(1). Ther ei snodoubtt hatl ar gescal e,car ef ul l ydesi gnedandcont r ol l ed st udi esmustbeconduct edt oel uci dat et her ol eofv ar i cocel ei ni nf er t i l i t y , and t o cl ar i f ywhi ch sper m f unct i on t estar eassoci at ed wi t hr educed f er t i l i t y pot ent i also t hatt hose who may benef i tf r om cor r ect i on of v ar i cocel ecanbei dent i f i ed(9).

Ref er ences: 1.Cat hyKN, Aj ayKN, AshokA.pat hophy si ol ogyofv ar i cocel ei nmal e i nf er t i l i t y .HumanRepr oduct i onUpdat e; 2005; 7, ( 5) : 47381. 2.Kl ai berEL,Br ov er manDM,Pokol yTB, et al .I nt er r el at i onshi psof ci gar et t esmoki ng, t est i cul arv ar i cocel e, andsemi nalf l ui di ndexes. Fer t i l St er i l ; 1987; 47: 481.

3.Si gman M and Jar ow JP.I psi l at er alt est i cul arhy pot r ophy i s associ at eddecr easedsper m counti ni nf er t i l emenwi t hv ar i cocel e. 4.Yamamot o M, Hi biH,Kat suno S,and Mi y ake K.Ef f ect of v ar i cocel ect omyon t est i sv ol ume and semen par amet er si n adol escent s:a r andomi zedpr ospect i v est udy .Nagoy aJMedSci 1995; 58: 12732. 5.Haust erR,Bot chan A,YogevLand Yav et zH.Var i cocel eand humani nf er t i l i t y ;ef f ectofv ar i cocel eonsper mf unct i on.Human Repr oduct i onUpdat e; 2001; 7, ( 5) : 48285. 6.Gonda RL,Kar o JJ,For t e RA,et al .Di agnosi s ofsubcl i ni cal v ar i cocel ei ni nf er t i l i t y .AJRAm JRoent genol .1997; 148: 713. 7.NashanD,Behr eHM,Gr uner tJH,et al .Di agnost i cv al ueofscr ot al sonogr aphyi ni nf er t i l emen: r epor ton658cases.Andr ol ogi a; 1990; 22: 387. 8.Pat elPJ,Par eekS.Scr ot alul t r asoundi nmal ei nf er t i l i t y .EurUr ol . 16: 42325. 9.Pi er i kFH, Vr eebur gJT,St i j nenTH,et al ;i mpr ov ementofsper m countandmot i l i t yaf t erl i gat i onofv ar i cocel edet ect edbycol or ed Doppl erul t r asonogr aphy .I ntJAndr ol ; 1998; 21: 25660. 10. Wor l d Heal t h Or gani zat i on.The i nf l uence ofv ar i cocel e on par amet er s off er t i l i t yi nal ar ge gr oup ofmen pr esent i ng t o i nf er t i l i t ycl i ni cs.Fer t i l St er i l ; 1992; 74: 4614. 11. Vi l l nuev aDC,VegaHE,Di azPM,et al .Sper m dy sf unct i oni n subf er t i l epat i ent swi t hv ar i cocel eandmar gi nalsemenanal y si s; Andr ol ogi a, 1999; 31: 647.

Tabl e1: Cor r el at i onbet weent hedi amet er sofpampi ni f or m pl exusmeasur ed byscr ot alDoppl erul t r asoundwi t ht hepar amet er soft hesemi nalf l ui d anal y si s ( concent r at i on,t ot alpot ent i alf unct i oni ngsper ms,mor phol ogy andmot i l i t y ) .

Conc. TPFS Rt . v ei n Lt . v ei n

Mor phol ogy

Mot i l i t y

Nor mal Abnor malAct i v e Sl uggi sh Non

0. 266 0. 292 0. 273

0. 209

0. 2

0. 272

0. 226 0. 249 0. 27

0. 253

0. 279 0. 269

0. 285 0. 22