Functional analysis of testes contains the illustration of macrovascularity and microvascularity, which are indicators of tissue perfusion. The correlation with testicular function was proven by a considerable number of trials, and established the CDS's sensitivity. The RI of testicular artery varies at this level between 0.75 and 0.88. The RI of intratesticular artery varies between 0.45 and 0.67. Some authors suggest that a threshold of intratesticular RI of 0.6 should be considered because the RI is usually below this threshold in normal tissue
11. In our study, the RI values of testicular arteries in the left and right testis were significantly lower in the patients with varicocele than the controls. However, these RI values of testicular arteries in both testes of the patient and control group are below the recommended threshold for testicular artery. Also, although PSV and EDV are reliable indicators for testicular artery, RI and PI are not recommended for this artery
6. We also found that there were no statistically significant differences between the groups according to the other parameters. Consequently, the testicular blood supplies were found similar in the groups. These results may depend on our study group because the patients in the study had normal semen parameters.
Unsal et al.12 published that the RI was an indicator of testicular microcirculation and was increased in case of clinical varicocele. They evaluated capsular and intratesticular branches of testicular artery in the patients with varicocele (n=15) and controls (n=34). The deficiencies of their study are absence of semen analysis and low number of patients in the study group. Although we measured the same parameters in these branches of testicular artery, none of these parameters were found different between the patient (n=40) and control (n=23) group. Previously, testicular artery blood flow was compared between the control group and varicocele group who had impaired sperm parameters. Tarhan et al.7 published that testicular blood flow was found to be significantly decreased in men with varicocele, which may be a reflection of impaired microcirculation. Hassan et al.8. similarly compared testicular blood supplies in the healthy and infertile males, but they did not evaluate semen analysis in the participants. Although these two studies showed that varicocele poorly effects testicular perfusion in infertile males, we found that varicocele does not have a decreasing effect on testicular blood supply in males who have normal sperm parameters. We think that when varicocele effects testicular blood flow, it may cause impaired sperm parameters or infertility. Low testicular blood flow in varicocele may be a predictive indicator for infertility.
Some researcher assessed effect on testicular blood flow of varicocelectomy. While Balci et al.5 measured PSV, EDV, RI and PI in intratesticular artery Tarhan et al.6 measured these parameters in testicular artery and its branches (capsular and intratesticular). Both studies noticed that testicular blood supply and sperm parameters significantly increased in six months after varicocelectomy. They also found that there were some correlations between sperm and testicular blood flow parameters.
Previous studies showed that both testicular blood flow and sperm parameters decreased in infertile patients with varicocele and these parameters recovered after treatment of varicocele. We found that testicular blood flow did not impair in the patients with varicocele who had normal sperm parameters. We suggest that testicular blood flow parameters may be a predictive indicator for infertility. These parameters may use to decide therapy or follow up male with varicocele and normal sperm parameters. We suggest that testicular blood flow in patients with varicocele and normal sperm parameters should be investigated by further studies with long term follow up.