Clinical significance of the use of intraoperative ultrasound dopplerography during Marmar surgery

Abstract

BACKGROUND: Intraoperative ultrasound Dopplerography is rarely used to facilitate the recognition and dissection of vascular structures during Marmar surgery.

AIM: The aim of the study is to compare the effectiveness of restoring the fertile properties of the ejaculate and the frequency of complications after Marmar surgery with and without intraoperative Doppler in patients with clinically significant varicocele and male infertility factor.

MATERIALS AND METHODS: The study included 96 men with a diagnosis of left-sided varicocele. The patients were divided into two groups. The group 1 included 41 patients who underwent Marmar surgery with intraoperative Doppler, and the group 2 included 55 patients but without the use of dopplerography. All patients were examined before the operation and three and six months after.

RESULTS: In the group 1 of patients, a more significant increase in the concentration and number of progressively mobile forms of sperm was noted three and six months after surgery, compared with similar indicators in patients of the group 2 (р < 0.05). The use of intraoperative Doppler significantly reduced the time of surgical intervention, the frequency of complications and relapses, the detection of venous and arterial vessels (р < 0.05). After Marmar surgery using intraoperative Doppler, there were no complications and relapses observed during six months of follow-up.

CONCLUSIONS: 1. Intraoperative Doppler control allows ligating a larger number of venous trunks and preserving a larger number of arteries in the spermatic cord during the Marmar surgery, thereby reducing the time of surgical intervention, preventing the development of relapses and complications of the disease. 2. The use of intraoperative Doppler during the Marmar surgery leads to a more significant increase in the concentration and number of progressively motile sperm forms both three and six months after the operation compared to the classical technique.

Keywords

intraoperative Doppler / Marmar surgery / spermogram / male infertility / fertility

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