The Evaluation of Platelet Volume Indices in Patients with Varicocele

Abstract

Objective: Varicocele is the abnormal venous dilatation and the tortuosity of the pampiniform plexus. Varicocele has been shown to be related with systemic varicosity in some studies. Platelet volume indices have also been reported to increase in vascular disorders. In this study, we aimed to determine if complete blood count (CBC) parameters especially platelet counts and volume indices could be a practical tool in the diagnosis and follow-up of varicocele.

Materials and Methods: The medical records of all patients who underwent varicocelectomy due to grade 2 or 3 clinical varicocele were reviewed. Examined parameters included patient demographic characteristics and preoperative CBC parameters [hemoglobin, white blood cell, platelet, mean platelet volume (MPV) and platelet distribution width (PDW)]. Patients without varicocele, active infection and vascular disorders constituted the control group.

Results: The study population consisted of 61 patients with varicocele and 62 control subjects. The mean age of the patients was 28.6 ± 6.2 years. Mean preoperative hemoglobin, WBC, platelet, MPV and PDW were 15.5 ± 1 g/dL, 7.5±1.6 x103/μL, (236 ± 53.4) x103/μL, 9.3±1.1 (fL) and 15.2± 3.9 (%), respectively. There was no difference between patients with varicocele and control subjects in terms of age, mean preoperative Hb, WBC and MPV. However, mean preoperative platelet count was significantly lower and mean PDW was significantly higher in varicocele patients compared to controls (p

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Grand J Urol 2021;1(1):6-8
DOI: 10.5222/GJU.2021.43531
Original Article – Andrology
© Copyright 2021 by GJU. This journal is published by Logos Medical Publishing. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial
License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Evaluation of Platelet Volume Indices in Patients with Varicocele
Varikoseli Olan Hastalarda Trombosit Hacim İndekslerinin Değerlendirilmesi
Mehmet Yilmaz1 , Mustafa Karaaslan2 , Cavit Ceylan2 , Senol Tonyali3
1 Department of Urology, Zile State Hospital, Tokat, Turkey
2 Department of Urology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
3 Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
Cite as:
Yilmaz M, Karaaslan M, Ceylan C, Tonyali S. The evaluation of platelet volume indices in patients with varicocele. Grand J Urol 2021;1(1):6-8.
Submission date: 04 December 2020 Acceptance date: 11 December 2020 Online rst: 17 December 2020 Publication date: 20 January 2021
ID ID ID ID
Corresponding Author: Mehmet Yilmaz / Zile State Hospital, Department of Urology, Tokat, Turkey
yilmazmehmet88@hotmail.com ORCID: 0000-0003-3774-9982
ORCID: M. Karaaslan 0000-0003-3453-3334 C. Ceylan 0000-0001-5159-1291 S. Tonyali 0000-0003-1657-4044
Abstract
Objective: Varicocele is the abnormal venous dilatation and the tortuosity of the pampiniform plexus. Varicocele has been shown to be related with
systemic varicosity in some studies. Platelet volume indices have also been reported to increase in vascular disorders. In this study, we aimed to determine
if complete blood count (CBC) parameters especially platelet counts and volume indices could be a practical tool in the diagnosis and follow-up of
varicocele.
Materials and Methods: The medical records of all patients who underwent varicocelectomy due to grade 2 or 3 clinical varicocele were reviewed.
Examined parameters included patient demographic characteristics and preoperative CBC parameters [hemoglobin, white blood cell, platelet, mean
platelet volume (MPV) and platelet distribution width (PDW)]. Patients without varicocele, active infection and vascular disorders constituted the control
group.
Results: The study population consisted of 61 patients with varicocele and 62 control subjects. The mean age of the patients was 28.6 ± 6.2 years. Mean
preoperative hemoglobin, WBC, platelet, MPV and PDW were 15.5 ± 1 g/dL, 7.5±1.6 x103/μL, (236 ± 53.4) x103/μL, 9.3±1.1 (fL) and 15.2± 3.9 (%),
respectively. There was no difference between patients with varicocele and control subjects in terms of age, mean preoperative Hb, WBC and MPV.
However, mean preoperative platelet count was signicantly lower and mean PDW was signicantly higher in varicocele patients compared to controls
(p<0.05).
Conclusion: We found that PDW is signicantly higher in varicocele patients compared to controls. Thus, PDW might be a practical tool in the
conrmation of varicocele diagnosis and also be utilized at follow-up after varicocelectomy.
Keywords: varicocele, platelet, blood, CBC
Öz
Amaç: Varikosel, anormal venöz genişleme ve pampiniform pleksusun tortiyoze olmasıdır. Bazı çalışmalarda varikoselin sistemik varikosite ile
ilişkili olduğu gösterilmiştir. Trombosit hacim indekslerinin de vasküler bozukluklarda arttığı bildirilmiştir. Bu çalışmada, tam kan sayımı (CBC)
parametrelerinin, özellikle trombosit sayısı ve hacim indekslerinin varikosel tanı ve takibinde kullanılıp kullanılamayacağını belirlemeyi amaçladık.
Yöntem ve Gereçler: Grade 2 veya 3 klinik varikosel nedeniyle varikoselektomi yapılan tüm hastaların tıbbi kayıtları gözden geçirildi. İncelenen
parametreler hasta demograklerini, ameliyat öncesi CBC parametrelerini [hemoglobin, beyaz kan hücresi, trombosit, ortalama trombosit hacmi (MPV)
ve trombosit dağılım genişliğini (PDW)] içeriyordu. Kontrol grubu varikoseli, aktif enfeksiyonu ve damar rahatsızlığı olmayan hastalardan oluşturuldu.
Bulgular: Çalışmaya 61’i varikoselli ve 62’si kontrol olmak üzere 123 hasta dahil edildi. Hastaların ortalama yaşı 28.6 ± 6.2 yıldı. Ortalama preoperatif
hemoglobin, WBC, trombosit, MPV ve PDW sırası ile 15,5 ± 1 g/dL, 7,5 ± 1,6 x103/μL, (236 ± 53,4) x103/μL, 9,3 ± 1,1 (fL) ve 15,2 ± 3,9 (%) idi.
Yaş, ameliyat öncesi Hb, Wbc ve MPV açısından varikoseli olan hastalarla kontroller arasında fark yoktu. Bununla birlikte, kontrollere göre varikosel
hastalarında ameliyat öncesi ortalama trombosit sayısı anlamlı olarak düşüktü ve ortalama PDW anlamlı olarak yüksekti (p <0.05).
Sonuç: Varikosel hastalarında PDW’nin kontrollere göre anlamlı olarak daha yüksek olduğunu bulduk. Bu nedenle PDW, varikosel tanısının
doğrulanmasında pratik bir araç olabilir ve aynı zamanda varikoselektomi sonrası takipte de kullanılabilir.
Anahtar Kelimeler: varikosel, platelet, kan

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Introduction
Varicocele is a disease characterized by abnormal enlargements
in the testicular vein and pampiniform plexus caused by various
factors [1]. Varicocele is found in about 15% of men and
represents the primary cause of male infertility in 35% of cases
[2]. The etiology of varicocele is multifactorial and the pathogenic
mechanisms of varicocele are unclear, but varicocele may lead to
increased venous pressure, high testicular temperature, oxidative
stress, hypoxia and ultimately testicular damage [3]. According
to previous studies, it is known that oxidative stress enhances
vascular inammation, which plays an important role in the
progression of atherosclerotic disease [4]. Varicocele is a vascular
disease and causes local and / or systemic inammation [5]. In
addition, a systemic vascular varicosity was positively correlated
with varicocele [6]. Changes in platelet function caused by
vascular damage can be associated with varicocele [2].
In this study, we aimed to determine if complete blood count
(CBC) parameters especially platelet count and volume indices
could be a practical tool in the diagnosis and follow-up of varicocele.
Materials and Methods
After obtaining institutional review board approval
(Approval Number: 2018/29620911-929), the medical records
of all patients who underwent varicocelectomy due to grade 2
or 3 clinical varicocele in Türkiye Yüksek İhtisas Training and
Research Hospital between 2014 and 2018 were retrospectively
reviewed. Patients who underwent unilateral varicocelectomy
without any active infection constituted the patient group.
Patients admitted to outpatient clinic with a complaint other than
infertility or scrotal pain without varicocele, active infection,
inammatory disease and vascular disorders constituted the
control group.
Statistical Analysis
IBM SPSS statistical package programme v.21 for Mac
(Armonk, NY, USA)was used. Quantitative variables were
given as mean ± standard deviation and qualitative values were
shown in numbers and percentages. Comparison of variables
between two groups was made by using Mann-Whitney U tests.
Statistical signicance was set as P <0.05
Results
The study included 61 patients with varicocele and 62
control subjects. The mean age of the patients was 28.6 ± 6.2
years. Mean preoperative hemoglobin, WBC, platelet, MPV and
PDW values were 15.5 ± 1 g/dL, 7.5±1.6 103/μL, 236 ± 53.4
x x103/μL, 9.3±1.1 (fL) and 15.2± 3.9 (%), respectively. There
was no difference between patients with varicocele and controls
in terms of age (28±6.8 vs 29.1±5.5years), mean preoperative
Hb (15.6±0.9 vs. 15.4±1.1 g/dL), WBC (7.4±1.6 vs 7.6±1.6
x103/μL)and MPV (9.3±1.1 vs 9.4±1fL). However, mean
preoperative platelet count was signicantly lower and mean
PDW was signicantly higher in varicocele patients compared
to controls (p=0.006 and p=0.001, respectively) (Table 1).
Discussion
Underlying pathogenesis of varicocelecan be related to
increased pressure in the pampiniform venous plexus and venous
drainage [7]. Many studies have been conducted in the literature
to elucidate the exact etiology of varicocele. In the literature, it is
reported that the presence of large platelets is a possible risk factor
for the diseases and the conditions such as testicular torsion,
varicocele, stroke, myocardial infarction and angina, coronary
artery atherosclerosis, malignancy, ulcerative colitis, familial
Mediterranean fever, Alzheimer’s disease and Behçet’s disease [5].
Most of the mediators necessary for coagulation, inammation,
thrombosis and atherosclerosis are secreted by platelets [8].
Vascular change and platelet indices may be useful for
detecting or screening subclinical varicocele [2]. Platelet indices
such as mean platelet volume (MPV), platelet distribution width
(PDW) and thrombocytecrit (PCT) are standard indicators of
platelet function in the pathophysiology of diseases [9]. MPV
is an important marker of platelet size and activation. However,
the results of the studies on this subject in the literature are
contradictory. In a study by Cüce et al., MPV values were found
to be signicantly higher in patients with varicocele than those
without (P = 0.010), but no statistically signicant relationship
was found between grade of varicocele and MPV and RDW
values [4]. Bozkurt et al. stated that the increase in MPV was due
to the varicocele disease and that the increase in the degree of
varicocele was associated with higher MPV in varicocele patients
[8]. In concordance with the aforementioned studies Coban et al.
found that MPV values were signicantly higher in the varicocele
group, and platelet and PDW values were signicantly lower
than in the control group [1]. In another study, in contrast with
our study, when the platelet (PLT), MPV, PCT and PDW values
of the varicocele and the non-varicocele groups were compared,
a signicant increase was observed in MPV (p = 0.003), but no
Table 1. Comparison of age and complete blood count variables
of varicocele patients and the control group
Variables Varicocele
(n=61)
Control
(n=62) P value
Age (yr) 28±6.8 29.1±5.5 0.096
Mean Preoperative
Hb (g/dL) 15.6±0.9 15.4±1.1 0.455
Mean Preoperative
WBC x 103/μL 7.4±1.6 7.6±1.6 0.482
Mean Preoperative
PLT x103/μL 222±47 249±56 0.006
Mean Preoperative
MPV (fL) 9.3±1.1 9.4±1 0.419
Mean Preoperative
PDW (%) 16.2±4.5 14.2±2.8 0.001
Hb: hemoglobin; WBC: white blood cell; PLT: platelet; MPV:
mean platelet volume; PDW: platelet distribution width
Yilmaz M, Karaaslan M, Ceylan C, Tonyali S. Varicocele and Platelet Incides

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difference was observed in the platelet count or platelet indices [3].
In another study by Polat et al.,platelet counts or indices
represented no difference between the groups with and without
varicocele in terms of MPV, PDW and PCT [9]. Mahdavi et
al. found that platelet volume indices [PVI (MPV, PDW, and
P-LCR)] was higher in varicocele patients compared to normal
healthy controls [10]. In our study, no signicant difference
was observed between the groups with and without varicocele
in terms of MPV, while the mean preoperative PDW value was
found to be signicantly higher in those with varicocele.
Our study is also not without limitations. One of the main
limitations of the study is that the study is its retrospective
design. In addition, the small number of patients and the fact
that we did not measure other platelet indices like (platelet-large
cell ratio (PLCR) and platelet-large cell concentration (PLCC)
and platelet activation markers such as beta-thromboglobulin
and platelet factor IV might be considered among the other
limitations of our study.
Conclusion
We found that PDW is signicantly higher in varicocele
patients compared to controls. Thus, PDW might be a practical
tool in the diagnostic conrmation of varicocele and also be
utilized at follow-up after varicocelectomy.
Ethics Committee Approval: The study was approved by
Training and Research Hospital Medical Specialty Education
Board (TUEK), Cankaya, Ankara, Turkey (Decision No: 15
March, 2018/29620911-929).
Informed Consent: An informed consent was obtained from all
the patients.
Publication: The results of the study were not published
elsewhere in full or in part in form of abstracts.
Peer-review: Externally peer-reviewed.
Authorship Contributions: Any contribution was not made by
any individual not listed as an author. Concept – M.Y., M.K.,
C.C., S.T.; Design – M.Y., M.K., C.C., S.T.; Supervision –
M.Y., M.K., C.C., S.T.; Resources – M.Y., M.K., C.C., S.T.;
Materials – M.Y., M.K., C.C., S.T.; Data Collection and/
or Processing – M.Y., M.K., C.C., S.T.; Analysis and/or
Interpretation – M.Y., M.K., C.C., S.T.; Literature Search –
M.Y., M.K., C.C., S.T.; Writing– M.Y., M.K., C.C., S.T.; Critical
Review – M.Y., M.K., C.C., S.T.
Conict of Interest: The authors declare that theyhave no
conict of interest.
Financial Disclosure: The authors have declared that they did not
receive any nancial support for the realization of this study.
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