SCROTAL THROMBOSIS, TESTICULAR PAIN AND VARICOCELE: A RARE CONDITION IN SEMEN ANALYSIS
In lab practice of semen analysis, it is usual the focus on the investigation of male infertility. In fact, semen analysis was born for the purpose of being used in this investigation and the vast majority of the semen analysis performed at the Lisa Andrology Lab and their partners also have this clinical setting.
On the other hand, it is interesting that in our semen analysis routine, which we called Advanced Seminal Analysis, we are periodically required for evaluating patients with clinical settings other than infertility. Likewise, we provide a significant aid for the diagnosis, because of the technology we developed for this lab test.
Within the proposal of the Lisalab Reports Project, in showing all work we have developed in Lisa Andrology Lab, we present here a case of a 21 years old patient, who recently looked for us for an Advanced Seminal Analysis. Two years earlier, this patient also took an advanced semen analysis in our laboratory to evaluate his fertility status and the likelihood of undergoing surgery, since he had a left varicocele like so many others carriers of varicocele in adolescence.
Surprisingly, in this second evaluation, he reported a history of a scrotal thrombosis, a very rare disorders in clinical practice that shortly affected him after the first Advanced Semen Analysis. Patient reported that scrotal thrombosis was treated at the time (with no information about it), but it remains active, even after two years of the diagnosis. It is worth mentioning that we have more than 20,000 tests performed with this technology. However, for the first time we attend a patient with this clinical setting. It should also be emphasized that the patient did not undergo varicocele surgery after the first examination.
We will now present the results of both Advanced Semen Analysis. It is important to emphasize that parameters assessed in Advanced Semen Analysis are extensive and we will show only those with significant changes. Some parameters that have not changed are also reported to illustrate the evolution of the analyzed samples. The reference values are those applied in our routine. Data are shown in the following table:
Clearly we observed that there were no major changes in parameters of both samples. The most significant changes in conventional parameters were in the sperm count / ml, vitality and sperm motility. Seemingly, these changes may have been caused by thrombosis, or even a worsening of the negative impact of varicocele on the semen quality after two years. However, it was observed that there was no significant change in sperm morphology, which is the most affected parameter in varicocele patients, according to expertise in Advanced Semen Analysis. We also have an index (not reported here) that measures the integrity of the germinal epithelium, which was normal in both samples This clearly shows that there was no loss of this integrity due to the scrotal thrombosis.
On the other hand, the table provides a special emphasis for the determination of the alkaline phosphatase activity, which made a huge leap from the first to the second Advanced Semen Analysis (results that were repeated and confirmed, how is customary in Lisa Andrology Lab). We performed this assay, because it gives many pathways of investigation. However, it would be very lengthy to explain now and we will do so at another season. Knowledge about seminal alkaline phosphatase show that it has a fraction produced by the testes and another from the prostate. We are studying how seminal levels of this enzyme may help for investigating these fractions. However, we do not have any available information. Actually, the levels alkaline phosphatase in both samples surprised us in this case report.
We do not have a consistent opinion on this change-over. We believe that thrombosis may have triggered this large increase in the second sample. Taking into account changes in levels of prostate markers, which are at normal reference in both samples, we hypothesized the likelihood of an increase in the testicular fraction at the later sample. Another fact that reinforces this hypothesis is the considerable increase in sperm counts between both samples, although no changes was detected in sperm morphology and germinal epithelium integrity.
Concerning to the smaller percentages of sperm vitality and motility in second sample, they might have been affected by thrombosis, or even by the varicocele. These hypotheses are suggestions of the Advanced Semen Analysis that we perform. However, it is impossible to prove in lab practice at a single case. Indeed, it can only be clarified after a large study about it. We recall that sperm motility develops during the transit of sperm through the epididymes, which are organs with distinct functions in relation to the testes.
We would also like to point out that this patient recently submitted to a color Doppler ultrasound of scrotum, which showed the presence of varicocele, cyst, hydrocele at left side. This ultrasound has not been performed at the first examination. Also at the time, the patient did not present testicular pain, which has only manifested after the scrotal thrombosis. They are relevant data. However, they give almost none information about the negative effects of this pathology on semen analysis, apart from the testicular pain.
Scrotal thrombosis is rare condition in clinical and laboratory practice and the outcome of alkaline phosphatase activity seems to have a relationship with this disease. We are now looking for new cases. However, because they are rare, we think we will be unable to perform a more detailed assessment of this pathology vs. outcomes of Advanced Semen Analysis afterward.
It is still necessary a comment on the plentiful bacterial flora and the mild leukocytospermia present in the both samples. This finding shows that they both have no relationship with scrotal thrombosis.
Overall, by analyzing data reported in the table above, it seems that there was no major damage to the fertility status of this patient due to the scrotal thrombosis, although this is also speculative and needs further investigations for more consistent information.
The technology that we have developed for Advanced Seminal Analysis has the merit of being able to report a diversity of information that gives a wide view on the function of the male genital organs and their disorders. Sometimes, it even surprises us with unexpected findings like the levels of alkaline phosphatase activity in this case report. The important thing is that they are primary or even supplementary information, which serves to assist in clinical practice, because of manifold interpretations of outcomes. This was the goal to be achieved when we developed this technology.
Contact Lisa Andrology Lab: lisalabrescenter@gmail.com
On the other hand, it is interesting that in our semen analysis routine, which we called Advanced Seminal Analysis, we are periodically required for evaluating patients with clinical settings other than infertility. Likewise, we provide a significant aid for the diagnosis, because of the technology we developed for this lab test.
Within the proposal of the Lisalab Reports Project, in showing all work we have developed in Lisa Andrology Lab, we present here a case of a 21 years old patient, who recently looked for us for an Advanced Seminal Analysis. Two years earlier, this patient also took an advanced semen analysis in our laboratory to evaluate his fertility status and the likelihood of undergoing surgery, since he had a left varicocele like so many others carriers of varicocele in adolescence.
Surprisingly, in this second evaluation, he reported a history of a scrotal thrombosis, a very rare disorders in clinical practice that shortly affected him after the first Advanced Semen Analysis. Patient reported that scrotal thrombosis was treated at the time (with no information about it), but it remains active, even after two years of the diagnosis. It is worth mentioning that we have more than 20,000 tests performed with this technology. However, for the first time we attend a patient with this clinical setting. It should also be emphasized that the patient did not undergo varicocele surgery after the first examination.
We will now present the results of both Advanced Semen Analysis. It is important to emphasize that parameters assessed in Advanced Semen Analysis are extensive and we will show only those with significant changes. Some parameters that have not changed are also reported to illustrate the evolution of the analyzed samples. The reference values are those applied in our routine. Data are shown in the following table:
Parameter
|
First examination
|
Second examination
|
References
|
Volume
|
2.5 mL
|
2.5 mL
|
2.0-5.0 mL
|
Viscosity
|
Hyperviscosity
|
Hyperviscosity
|
-
|
pH
|
7.4
|
7.4
|
7.3-7.8
|
Fructose *
|
1.5 mg/mL
|
1.7 mg/mL
|
1.1-5.0 mg/mL
|
Inorganic phosphorus*
|
362 µg/mL
|
347 µ/mL
|
691-887 µ/mL
|
Total calcium**
|
409 µ/mL
|
235 µ/mL
|
230-395 µ/mL
|
Acid phosphatase**
|
584 U/mL
|
1.045 U/mL
|
135-1.129 U/mL
|
Zinc**
|
117 µ/mL
|
99 µ/mL
|
81-138 µ/mL
|
Alkaline phosphatase
|
17 U/mL
|
1.543 U/mL
|
50-100 U/mL
|
Sperm count/mL
|
22 x 10(6)
|
102 x 10(6)
|
>15 x 10(6)
|
Vitality
|
75%
|
48%
|
>58%
|
Total motility
|
43%
|
34%
|
>40%
|
Progressive motility
|
37%
|
33%
|
>32%
|
HOST***
|
55%
|
51%
|
>58%
|
Normal morphology
|
6.03%
|
7.47%
|
>4%
|
Leukocytes/mL
|
1.06 x 10(6)
|
1.54 x 10(6)
|
<1.0x106/mL
|
Bacteria
|
Plentiful
|
Plentiful
|
-
|
*seminal vesicles markers ** Prostate markers *** Hypoosmotic Swelling Test
On the other hand, the table provides a special emphasis for the determination of the alkaline phosphatase activity, which made a huge leap from the first to the second Advanced Semen Analysis (results that were repeated and confirmed, how is customary in Lisa Andrology Lab). We performed this assay, because it gives many pathways of investigation. However, it would be very lengthy to explain now and we will do so at another season. Knowledge about seminal alkaline phosphatase show that it has a fraction produced by the testes and another from the prostate. We are studying how seminal levels of this enzyme may help for investigating these fractions. However, we do not have any available information. Actually, the levels alkaline phosphatase in both samples surprised us in this case report.
We do not have a consistent opinion on this change-over. We believe that thrombosis may have triggered this large increase in the second sample. Taking into account changes in levels of prostate markers, which are at normal reference in both samples, we hypothesized the likelihood of an increase in the testicular fraction at the later sample. Another fact that reinforces this hypothesis is the considerable increase in sperm counts between both samples, although no changes was detected in sperm morphology and germinal epithelium integrity.
Concerning to the smaller percentages of sperm vitality and motility in second sample, they might have been affected by thrombosis, or even by the varicocele. These hypotheses are suggestions of the Advanced Semen Analysis that we perform. However, it is impossible to prove in lab practice at a single case. Indeed, it can only be clarified after a large study about it. We recall that sperm motility develops during the transit of sperm through the epididymes, which are organs with distinct functions in relation to the testes.
We would also like to point out that this patient recently submitted to a color Doppler ultrasound of scrotum, which showed the presence of varicocele, cyst, hydrocele at left side. This ultrasound has not been performed at the first examination. Also at the time, the patient did not present testicular pain, which has only manifested after the scrotal thrombosis. They are relevant data. However, they give almost none information about the negative effects of this pathology on semen analysis, apart from the testicular pain.
Scrotal thrombosis is rare condition in clinical and laboratory practice and the outcome of alkaline phosphatase activity seems to have a relationship with this disease. We are now looking for new cases. However, because they are rare, we think we will be unable to perform a more detailed assessment of this pathology vs. outcomes of Advanced Semen Analysis afterward.
It is still necessary a comment on the plentiful bacterial flora and the mild leukocytospermia present in the both samples. This finding shows that they both have no relationship with scrotal thrombosis.
Overall, by analyzing data reported in the table above, it seems that there was no major damage to the fertility status of this patient due to the scrotal thrombosis, although this is also speculative and needs further investigations for more consistent information.
The technology that we have developed for Advanced Seminal Analysis has the merit of being able to report a diversity of information that gives a wide view on the function of the male genital organs and their disorders. Sometimes, it even surprises us with unexpected findings like the levels of alkaline phosphatase activity in this case report. The important thing is that they are primary or even supplementary information, which serves to assist in clinical practice, because of manifold interpretations of outcomes. This was the goal to be achieved when we developed this technology.
Contact Lisa Andrology Lab: lisalabrescenter@gmail.com
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