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Antegrade scrotal venography. Persistence of dilated spermatic cord and cremasteric veins after varicocelectomy and embolization.
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Varicoceles affect approximately 15% of male patients, most of whom have resolution of symptoms and objective findings with microscopic subinguinal varicocelectomy. We present an interesting case of a 16-year-old male patient with persistent symptomatic varicocele despite varicocelectomy and gonadal vein embolization.
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Context 1
... was referred to our institution's urologic microsurgeon. Antegrade scrotal venography demonstrated dilated retroperitoneal collaterals from the pampiniform plexus to the left renal vein, communicating with unligated cremasteric veins. The cremasteric veins were not ligated and not accessible by retrograde venous embolization (Fig. ...
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Varicocele is characterized by abnormal tortuosity and dilation of the veins of the pampiniform plexus within the spermatic cord. Although several reports show the mechanisms by which the varicocele exerts its infertility impact, the exact pathophysiology for varicocele-induced inflammation and its relationship with testicular endocrine disruption...
Varicocele is the most common correctable cause of infertility. Color Doppler Ultrasound (CDUS) has a sensitivity of 97% and specificity of 94% for diagnosing this condition. This study aimed to propose a new pattern of scrotal Doppler for predicting the severity of varicocele. An observational study was conducted from January 2016 to January 2017...
Citations
... The most used approach is the retrograde endovascular approach, mainly with coils. However, nowadays an interventional radiologist's preference is still the most relevant criteria to choose the approach and the embolic material for varicocele treatment [3,4]. In this case, we describe the use of glue by antegrade approach for varicocele embolization. ...
... Diagnostics 2020, 10, x FOR PEER REVIEW 2 of 3 used approach is the retrograde endovascular approach, mainly with coils. However, nowadays an interventional radiologist's preference is still the most relevant criteria to choose the approach and the embolic material for varicocele treatment [3,4]. In this case, we describe the use of glue by antegrade approach for varicocele embolization. ...
... The entrapment of the microcatheter is exceptional in clinical practice if embolization is performed properly. There are not only a few cases with percutaneous antegrade varicocele embolization via the testicular vein at the level of the pubis, but also no reports of cyanoacrylate glue embolization in such a setting as we herein described [3,4]. ...
We report a case of a 29-year-old male referred to our hospital for endovascular treatment of a left-sided painful varicocele. Standard retrograde embolization via the left renal vein was not possible because of the presence of a left circum-aortic renal vein making the catheterization of the testicular vein not feasible. The patient was successfully treated via ultrasound-guided percutaneous antegrade access of the testicular vein at the inguinal level with subsequent cyanoacrylate glue embolization as a minimally invasive alternative to surgical therapy. This is a new approach to varicocele embolization when the left renal vein does not feed the varicocele.
Varicocele is a more common male genitourinary system disease with sperm quality dysfunction or discomfort. This study was aimed to compare the clinical efficacy of sclerosing embolization with 3% polidocanol and the microsurgical subinguinal varicocelectomy in treating primary varicocele. Total of 59 patients with primary varicocele receiving a 3‐month postoperative follow‐up were included to analyse their biochemical parameters and clinical outcomes, including the operative time, hospitalization time, postoperative recurrence rates, and complication rate. Nineteen patients were treated with sclerosing embolization with 3% polidocanol (SE group), while 40 patients were treated with microsurgical subinguinal varicocelectomy (MSV group). For the SE group, 17 patients were treated on the left side, and two patients have treated on both without recurrences and complications during the follow‐up period. For the MSV group, three patients were treated bilaterally, and 36 patients were treated separately on the left side with a total 5% recurrence rate and 10% complication rate. The duration of surgery and the hospitalization time of the SE group (46.2 ± 9.79 min and 2.53 ± 0.90 days, respectively) are significantly lower than MSV group (100.5 ± 13.76 min and 3.6 ± 1.58 days, respectively), p < 0.05. The total sperm count at 3 months was significantly higher in the SE group than in the MSV group (p < 0.05). In summary, sclerosing embolization is more effective for varicocele in improving sperm quality, shortening recovery time, and reducing recurrence rates and complications.
Ultrasound imaging and angiography play a crucial role in the diagnosis and treatment of men with subfertility. The most commonly used imaging modality is ultrasound (US), which can be used for diagnostic purposes or to aid in treatment. Scrotal US can be used to document varicoceles in subfertile men in the context of difficult examination or for confirmation before treatment. Spectral Doppler, sonoelastography, and power Doppler have aided in the evaluation and treatment of azoospermia and oligospermia. They have proven useful in the detection of spermatogenesis and sperm retrieval. In the population with congenital Wolffian duct abnormalities, renal US can evaluate renal anomalies. In subfertile men with low ejaculate volume and oligospermia or azoospermia transrectal US can be used to evaluate and assist in treatment of ejaculatory duct obstruction. Non-US-based modalities are also commonly used in evaluating and treating men with subfertility. Magnetic resonance imaging (MRI) can be used for evaluation of pituitary adenomas in hypogonadism. More invasive imaging modalities used during treatment of subfertile men include vasography for vasal obstruction, venography and angioembolization for varicocele, and US-guided needle placement for testis-sparing surgery. Male subfertility is a complex problem and the use of imaging techniques is often essential in providing accurate diagnosis and appropriate treatment.
