Internal Spermatic Vein Histopathology in Patients Undergoing Varicocelectomy

Overview

Varicocele is an enlargement of the veins around the testicle and may affect male fertility. This prospective observational study will include men with varicocele who are undergoing varicocelectomy. The study aims to examine whether changes in the structure of the internal spermatic veins are related to clinical findings, semen analysis results, and scrotal duplex ultrasound findings. During varicocelectomy, vein tissue that is removed as part of the surgical procedure will be collected and examined under a microscope. Digital image analysis will also be used to measure different features of the vein wall, including its thickness and the amounts of smooth muscle and collagen. In participants undergoing surgery for varicocele on both sides, the findings from the left and right spermatic veins will also be compared. The study does not assign participants to varicocelectomy; the decision to perform surgery is based on their clinical care.

This prospective cohort study will include male patients with clinically palpable varicocele who are scheduled to undergo varicocelectomy at Assiut University Hospitals. Preoperative assessment will include clinical evaluation, semen analysis, and scrotal duplex ultrasonography. Clinical assessment will include age, laterality, and clinical varicocele grade. Semen parameters will include semen volume, sperm concentration, total sperm count, progressive motility, non-progressive motility, and sperm morphology. Duplex ultrasound assessment will include right and left testicular volume, maximum spermatic vein diameter, presence of venous reflux, and reflux duration. Internal spermatic vein specimens excised during varicocelectomy will undergo histopathological and digital morphometric assessment. Specimens will be routinely processed and stained with hematoxylin and eosin and Masson's trichrome. Digital morphometric analysis will be performed using QuPath to quantitatively assess total venous wall area, wall thickness, wall-thickness-to-lumen-diameter ratio, smooth-muscle area, collagen area, and muscle-to-collagen ratio. The relationships between these histopathological measurements and clinical characteristics, duplex ultrasound findings, and semen parameters will be evaluated. In participants with bilateral varicocele undergoing bilateral varicocelectomy, left and right spermatic vein specimens will be assessed separately to allow paired comparison of histopathological and quantitative morphometric findings and their relationships with corresponding side-specific clinical and duplex ultrasound findings.