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Gubernacular and external spermatic veins are stripped. (a) The testis is delivered out of the incision, and the gubernacular and external spermatic veins are clearly visible. (b) Gubernacular and external spermatic veins are ligated and stripped.
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We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital (Shanghai, China). In this surgical approach, the testis was delivered, and the gubernacular and external cremasteric veins were stripped. In addition, the spermatic cord...
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Background: Semen analysis measures ejaculate volume, pH, sperm count, motility, forward progression, and morphology. Although semen analysis is not a test for infertility, it is considered the most important laboratory test in the evaluation of male fertility. There are many factors affecting the seminal fluid parameters and testicular varicocele...
Citations
... However, they did not find any significant pain. In addition, they observed a substantial improvement in the progressive sperm counts (Tian et al., 2020). ...
Background
Previously, we highlighted the benefits of magnified subinguinal varicocelectomy over conservative treatment on the semen of a small group of adolescents with varicoceles. In this report, we presented changes of semen parameters of 47 adolescents who underwent magnified subinguinal varicocelectomy (MSV) and followed-up for 6 months.
Methods
The present prospective controlled study was conducted on 47 adolescents with varicocele who underwent MSV and were followed up for 6 months. In addition, age and sex-matched patients were added as control group. The primary outcome of this study was to assess the postoperative change in semen analysis parameters.
Results
A significant increase in sperm volume from 2.5 (1.9–3) to 3.2 (2.6–4) mL at the end of the sixth month of follow-up. Likewise, the sperm count increased from 10.8 (3.51–21.6) to 20.3 (9.6–35) million. Notably, the percentage of rapid and slow sperms increased significantly from a median of 5% (0%–10%) and 15% (10 -20%) to a median of 10% (5%–15%) and 17.5% (15%–25%), respectively. The percentage of sperm with progressive movement increased from 35% (30%–40%) to 59% (45%–69%). The vitality of the sperms increased significantly as well. While the percentage of sperms with abnormal morphology decreased significantly at the end of follow-up.
Conclusion
Our findings support the safety and efficacy of MSV in patients with clinically detectable varicocele. MSV has improved the semen parameters of the included patients, including sperm motility, volume, count, and total progressive motility, which may positively impact their fertility potential.
... The microsurgical technique was superior to open techniques, with only 0.44% of hydrocele formation vs. 7.30-8.24% in the latest [14]. Damage to the spermatic cord arteries and lymphatics during surgery may lead to atrophy and necrosis of the testis and hydrocele formation [15]. We can suspect that the same mechanism applies in removing the sarcoidosis of the spermatic cord. ...
Background
Sarcoidosis is a multi-system disease characterized by the formation of non-caseating granulomas in various organs. The lungs remain the most frequently affected organ, whereas lesions in the genitourinary system affect around 0.2% of patients. The primary site found in the spermatic cord is extremely rare.
Case presentation
We present a patient’s case where the spermatic cord involvement was the first manifestation of sarcoidosis. For several months, a number of tests had been performed, which showed, among others, non-caseating granulomas in pathomorphological material, bilateral hilar lymphadenopathy, and leukopenia with lymphopenia. Tumor markers were normal. Infection with urogenital pathogens (including Chlamydia Trachomatis , Neisseria gonorrhea, Mycoplasma hominis ) was excluded. The patient did not report any general symptoms such as fever, excessive fatigue, weight loss. He denied swelling, shortness of breath. At the same time, a complete differential diagnosis was carried out, and the extent of the disease was assessed. Due to interdisciplinary management, the patient’s quality of life and fertility is preserved. In the discussion, we present the diagnosis, treatment, and prognosis of such patients.
Conclusion
Sarcoidosis is a multi-system disease, which should not be omitted in the differential diagnosis. Selective excision of the lesion with intraoperative examination plays a significant role while establishing a diagnosis. However, in the primary site in the genitourinary system, the diagnosis is challenging.
... Physical examination and vascular doppler help in the diagnosis [10]. MISV increases spontaneous postoperative pregnancy rates and the success of artificial conception methods and improves seminal parameters [3, [33][34][35]. It has reduced the percentage of recurrence, hydrocele formation and postoperative pain compared to other conventional surgical procedures [36][37][38]. ...
Varicocele is primarily tortuous dilation of the internal spermatic vein [ISV] and pampiniform plexus in the scrotum. It’s the most common correctable cause of infertility. It has a higher prevalence in primary and secondary infertility in men. In this article, we reviewed the advantages and disadvantages of microscopic intermediate sub inguinal [MISV] varicocelectomies over conventional surgical methods. Although various mechanisms are postulated for pathogenesis, increased venous reflux is accepted as the predominant cause. Varicocelectomy is done to ligate the veins and reduce venous reflux without affecting the arteries, vas deferens and lymphatics. Open, laparoscopic and microscopic varicocelectomies are the different surgical approaches of varicocele. Embolization is another treatment option. MISV is a relatively novel technique and considered superior to the conventional treatment approaches because of increased spontaneous pregnancy rates, reduced recurrence, increased seminal parameters and fewer postoperative complications, as evidenced by many studies. Microscopic visualization and usage of micro-doppler in surgery gives more safe and easy handling of the operative field. Absolute indications for varicocelectomy are documented infertility, clinically palpable varicocele abnormal seminal parameters and potentially treatable female infertility or normal fertility. Persistent pain, discrepancies in the testicular volume of more than 20% and hypogonadism are considered as relative indications for varicocelectomies. MISV should be regarded as the gold standard treatment method for varicocele.
... In this method, a small incision of the abdomen near the outside of the penis and over the testis and with the aid of a microscope is performed. [4,5] The advantage of this method is to maintain artery, lymphatic and nerve, and the rate of relapse is also lower (about 1 to 2%). The next method is inguinal surgery, which is almost the same as the first one, but without a microscope, and so its complications are higher (recurrence 9 to 16% and hydrocele 3 to 39%). ...
Background:
Based on the importance of varicocele, the aim of this is to compare the comparison between doppler sonography before and after laparoscopic lymphatic sparing varicocelectomy and microsurgical subinguinal varicocelectomy.
Patients and methods:
Patients with primary varicocele who were referred to Ahwaz Imam Khomeini Hospital after informed consent were included. Primary information included varicocele severity, pain intensity, latency, Doppler sonography (Resistive index (RI), venous return, venous diameter before and after Valsalva) were obtained, and then patients were entered into one of the two groups of surgery. The admission duration, return to work duration, the pain and analgesic consumption, and the length of anxiety were recorded in patients. Patients were examined 3 months later, and the severity of varicocele in the examination, pain score, latency, Doppler sonography indices, sperm indices in both groups were registered. In the end, the information is entered into Statistical Package for the Social Sciences (SPSS) statistical software and evaluated.
Results:
We observed that the severity of varicocele (P = 0.34), pain (P = 0.45), latralite (P = 0.56), RI (P = 0.65), intravenous diameter (P = 0.75) did not show statistically significant difference between the two groups, also in evaluating these indices after surgery, there were significant differences between the two groups in pain (P = 0.04) and time for return to work (P = 0.036).
Conclusions:
The methods used in varicocelectomy did not have any effect on the outcome of the treatment. Accordingly, using any of these methods can improve the post-surgical state of the patients and promote the fertility performance and reduction of complications due to surgery in patients.
The three‐dimension digital image microscope system (3D‐DIM) with a better ergonomic design and equipment characteristics can contribute to the achievement of good results during microsurgery. In this study, the safety and efficiency of 3D‐DIM assisted varicocelectomy was evaluated. From July 2019 to November 2019, fifteen cases with varicocele (20 sides of varicocele in total) were included, seven cases underwent 3D‐DIM‐assisted modified microsurgical subinguinal varicocelectomy, and eight cases underwent modified microsurgical subinguinal varicocelectomy under standard operating microscope (SOM). The mean operative time of 3D‐DIM group (67 ± 12.3 min) was a little longer than that of SOM group (55 ± 12.9 min) (p < 0.05). There was no significant difference between the two groups in the number of internal spermatic arteries, internal spermatic vein, lymphatics, gubernacular vein, external spermatic vein and post‐operation complications. The 3D‐DIM showed a significant difference in image definition for nurse (p < 0.01) and in doctor–nurse cooperation (p < 0.05) over SOM. The 3D‐DIM with better ergonomic design and image definition can be applied to perform microsurgical subinguinal varicocelectomy, and could improve the surgeon's fatigue and doctor–nurse cooperation. We believe that the 3D‐DIM would be widely used in the field of male infertility microsurgery in the near future.
Background:
Varicocele-associated stressors, such as hypoxia and heat, can damage cell function and viability, and some exosomal biomarkers released from impaired cells may reflect the cell status in testis.
Objectives:
To find if seminal exosomal microRNAs can reflect the Sertoli cell function in varicocele.
Materials and methods:
Experimental left varicocele rat model was established (n=24) and patients with different grades of varicocele (n=104) were enrolled. Primary rat Sertoli cells were isolated with enzymatic hydrolysis. Exosomes were isolated from primary rat Sertoli cells, rat epididymis tissue and human seminal plasma with polymer-based precipitation method. Exosomal microRNAs were quantified with qPCR. Inhibin-B was detected with enzyme immunoassay. The correlation analysis between microRNA and inhibin-B was evaluated with Spearman's correlation.
Results:
We screened 12 previously reported hypoxia-responsive microRNAs in the primary rat Sertoli cells, and found that 4 exosomal microRNAs increased significantly in response to in-vitro hypoxia treatment (p<0.05). Of the 4 microRNAs, only miR-210-3p was up-regulated in the rats with experimental varicocele (p<0.01). In the patients with varicocele, we found that seminal exosomal miR-210-3p significantly increased in patients with grade II and III varicocele (p<0.01), and miR-210-3p negatively correlated with sperm count (p<0.01) and seminal inhibin-B expression (r=-0.39, p<0.01). For the 30 patients with microsurgical varicocelectomy, the operation notably decreased miR-210-3p (p<0.01).
Discussion and conclusion:
Seminal exosomal miR-210-3p may be a novel, sensitive and noninvasive biomarker of Sertoli cell damage in varicocele.
