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Varicocele is a common finding in adolescents and adult men. Its association with male infertility has been well documented: varicoceles are reported to be present in 20-40% of infertile men. It has been demonstrated that varicocele correction leads to an improvement in the quality of semen in most cases. Percutaneous sclerotherapy is an establishe...
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... be performed using local anesthesia during the same procedure. Actually we used to perform retrograde percutaneous sclerotization in the operating room so that an antegrade procedure could be done at once if necessary: this combined approach allows successful treatment of all kinds of varicocele by means of retrograde or antegrade sclerotherapy ( fig. 4) in a simple ...
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Varicocele repair in adolescent remains controversial. Our aim is to identify and combine clinical trials results published thus far to ascertain the efficacy of varicocelectomy in improving testis volume and semen parameters compared with nontreatment control. A literature search was performed using Medline, Embase and Web of Science, which includ...
Varicocele is the most common correctable cause of male infertility. It is found in 35 and 80% of patients with primary and secondary infertility respectively. The most effective treatment for varicocele is surgery. Varicocelectomy is associated with a lot of complications, hydrocele is the most common of which, and it affects about 20% of patients...
Objective:We evaluated the outcomes of varicocelectomy in men with non-obstructive azoospermia (NOA) and a palpable varicocele.Materials and Methods:We retrospectively evaluated 25 male patients with NOA having a palpable varicocele, between May 2006 and December 2018. Age, duration of infertility, testicular volume, grade and side of varicocele, v...
Varicocele, the most important treatable cause of male infertility, is present in 15% of adult males, 35% of men with primary infertility, and 80% of men with secondary infertility. On the other hand, 80% of these men will not present infertility. Therefore, there is a need to differentiate a varicocele that is exerting a deleterious effect that is...
We report the case of a young woman admitted because of several and recurring episodes of macroscopic hematuria beginned after her first pregnancy. Contrast-enhanced multidetector computed tomography images showed dilated ovarian veins due to a typical pelvic varicocele. We supposed to be a right ovarian vein syndrome, a rare clinical situation cha...
Citations
... Varicocele treatment options continue to evolve over time, one of the main choices now is percutaneous varicocele embolization which is a minimally invasive technique requiring only local anaesthesia and interventional radiology expertise with minimum complications [7] . ...
... Trombetta et al., 2013 mentioned that the targeted overall reported technical success rate, as cited by the Journal of Vascular and Interventional Radiology quality improvements guidelines, is 83 to 96% [10] . In our study, we included 13 patients, we failed to catheterize the right internal spermatic vein in one case with technical success rate of 93.75%. ...
... As regard technical sucess , in our study , in one case we failed to cathetrize the diseased left gonadal vein via both jugular and femoral approach with technical success rate 95%. Trombetta et al. (9) , concluded that targeted overall reported technical success rate, as cited by the Journal of Vascular and Interventional Radiology quality improvements guidelines, is 83 to 96%, with a clinical or imaging detected recurrence rate at 6 weeks of 7 to 16%. These numbers reflect the range of reported results (9) . ...
... Trombetta et al. (9) , concluded that targeted overall reported technical success rate, as cited by the Journal of Vascular and Interventional Radiology quality improvements guidelines, is 83 to 96%, with a clinical or imaging detected recurrence rate at 6 weeks of 7 to 16%. These numbers reflect the range of reported results (9) . ...
... Venography is then performed again: should there be bulky veins, the operation is repeated at a higher lumbar level. After this procedure, a control venography is performed to confirm the absence of renospermatic reflow (Trombetta et al., 2003;Liguori et al., 2010). ...
We reviewed a large number of patients from 2000 to 2010 that underwent varicocoele correction using the retrograde sclerotization approach. Three hundred and seventy-six of them were included in the study, as they met the inclusion criteria. Mean age at the time of surgery was 32 years (SD: 6.5); 32% of them were 35 years and older. Patients were classified according to the clinical classification (GC) and Sarteschi's Doppler ultrasound classification (GS). The patients showed up at the clinic after an average time of 30 months of referred infertility related (SD: 28.54). Patients underwent pre-operative assessment with physical examination, sperm analysis and Doppler ultrasound, and again the same assessment at least 3 months after surgery. We evaluated the following parameters: sperm concentration (millions/mL, CONC), percentage motility (a+b, MOT) and the percentage of morphologically typical spermatozoa (MOR). Univariate and Multivariate analysis were performed. The research of Pearson's coefficients was performed to test the correlation between sperm parameters and age, SG, CG. Semen specimens were evaluated according to WHO 1999 criteria. Mean CONC varied from 34.5 to 47.0 millions/mL (+12.5; p < 0.001); MOT from 27.2 to 34.5% (+7.3%; p < 0.001); and MOR from 44.0 to 47.6% (+3.6%; p = 0.001). Univariable and multivariable analysis of variance related to age showed no significant difference of parameters improvement. Pearson's correlation coefficient for pre-operative and post-operative sperm MOT related to patients' age was respectively −0.11 (p < 0.001) and −0.18 (p = 0.04). No other significance was found. Usefulness of treating infertile patients affected by varicocoele is confirmed: varicocoele correction leads to significant sperm parameters improvement. There is no evidence of different improvement related to patients' age. The decline in sperm motility related to age of the patients seems to be only age-dependent: the usefulness of treating patients affected by varicocoele is not influenced by their age: treatment should also be offered to older patients.
... Venography is then performed again: should there be bulky veins, the operation is repeated at a higher lumbar level. After this procedure, a control venography is performed to confirm the absence of renosper-matic reflow (9,10). It is known from the literature that up to 20% of patients have anatomical abnormalities of their veins, that could eventually make not possible the retrograde technique. ...
Objectives:
To determine whether there are differences in sperm parameters improvement after different varicocele correction techniques. To determine the role of age in sperm parameters improvement.
Methods:
2 different European centers collected pre- and postoperative sperm parameters of patients undergoing varicocele correction. Among 463 evaluated patients, 367 were included. Patients were divided in procedure-related and age-related groups. Ivanissevich inguinal open surgical procedure (OS), lymphatic-sparing laparoscopic approach (LSL) and retrograde percutaneous transfemoral sclerotization (RPS) were performed. As outcome measurements sperm count (millions/mL, SC) and percentage of mobile sperms were analyzed. Univariate and multivariate regression between the defined groups; bivariate regression analysis between age and sperm count and motility.
Results:
Number of patients: OS 78; LSL 85; RPS 204. Mean age 30.2 (SD 6.83); postoperative SC increased from 18.2 to 30.1 (CI 95% 27.3-32.9; p < 0,001); motility from 25.6 to 32.56% (30.9-34.2; p < 0.001). OS: SC varied from 16.9 to 18.2 (p < 0.001); sperm motility from 29% to 33% (p < 0.001). LSL: SC from 15.5 to 17.2 (p < 0.001); motility from 27 to 31% (p < 0.001). RPS: SC from 18.9 to 36.2 (p < 0.001); motility from 24% to 32% (p < 0.001). Univariate and multivariate analysis confirmed the significant difference of SC variation in RPS, compared to the other groups (p < 0.001). No significance between LSL and OS (p = 0.826). No significant differences regarding motility (p = 0.8).
Conclusions:
Varicocele correction is confirmed useful in improving sperm parameters; sclerotization technique leads to a better sperm improvement compared to other studied procedures; improvement in seminal parameters is not affected by age of the patients treated.
... Venography is then performed again: should there be bulky veins, the operation is repeated at a higher lumbar level. After this procedure, a control venography is performed to confirm the absence of renosper-matic reflow (9,10). It is known from the literature that up to 20% of patients have anatomical abnormalities of their veins, that could eventually make not possible the retrograde technique. ...
... Sperm concentration, motility, and percentage of normal sperm cells are typically altered in infertile men with varicocele. 2,3 Even the role of varicocele correction in improving these parameters is still debated. 1,2,4 Several studies related different preoperative parameters with the effectiveness of surgical varicocele correction: mainly varicocele size, classification, and age of patients treated. ...
... 2,3 Even the role of varicocele correction in improving these parameters is still debated. 1,2,4 Several studies related different preoperative parameters with the effectiveness of surgical varicocele correction: mainly varicocele size, classification, and age of patients treated. [5][6][7] However, the role of these parameters in the effectiveness of varicocele correction is not completely clear too. ...
To determine the relationship between renospermatic basal reflow at color Doppler ultrasound (CDU) evaluation and the improvement in seminal quality after sclerotization of varicocele, and the role of patients' age. No clear predictive factors are available for selecting patients who will show a better seminal improvement after varicocele correction.
Between 2002 and 2008 we selected 113 patients with left unilateral varicocele, meeting the criteria of low sperm density, no endocrinological failures and no varicocele recidivating. Varicocele correction was performed using the retrograde sclerotization technique or, if not possible, the anterograde one. Patients underwent a physical examination, follicle-stimulating hormone assessment, sperm analysis (density, motility, and morphologic analysis), scrotal ultrasound, and CDU evaluation. Patients were divided into 5 groups using the CDU classification (Sarteschi). Three months postoperatively, they were assessed with the same protocol. Mean age was 32.2 years.
We found improvement in seminal quality among the entire population. We found no significance in differences among semen quality improvement in patients of different ages. Patients with basal renospermatic reflow at preoperative CDU evaluation (groups 3, 4, and 5) showed a better improvement in sperm density (+139%) than patients with no basal reflow (groups 1 and 2; +61%).
The presence of a basal reflow at preoperative CDU is a strong predictive factor of a better seminal quality improvement after varicocele correction. On the contrary, patient's age showed no significant relationship.
... Improved pregnancy rates are seen in a number of studies, however, a Cochrane review of five randomized studies of varicocele repair revealed no overall improvement in pregnancy rates. [23][24][25][26][27] Whether improvements in sperm quality directly result in increased pregnancy rates is unclear but many clinicians favour repair of varicoceles in infertile couples. 28 In terms of symptomatic varicoceles, Alqahtani et al. 29 reported 41 patients who underwent percutaneous embolization for symptomatic disease. ...
A testicular varicocele represents an abnormal degree of venous dilatation of the pampiniform plexus. It is a relatively common condition and may present at scrotal pain and swelling. An association with mate subfertility is an area of debate. This article describes the present day radiological criteria and imaging techniques to aid accurate diagnosis of varicoceles. In addition, the role of the interventional radiologist in treating this condition is discussed. (c) 2005 The Royal College of Radiologists. Published by Elsevier Ltd. All. rights reserved.
Die Harnabflussstörung als Folge einer retrograden Varikozelensklerosierung ist eine sehr seltene Komplikation. Sie kann meist durch korrekte Applikation des Sklerosierungsmittels im Bereich der Iliakalgefäße vermieden werden, da die V. testicularis dort weit vom Harnleiter entfernt verläuft. Bei Nachweis eines Paravasates durch Perforation oder aber erschwerter Sondierung der V. testicularis sollte die retrograde Sklerosierung nicht durchgeführt werden. Kommt es aber postoperativ zu einer Harnabflussstörung, ist die passagere Einlage einer DJ-Schiene über zumindest 4 Wochen die Therapie der Wahl. Zur Erhärtung der Diagnose sollte zunächst ein IVP angefertigt werden, eine Computertomografie des Abdomens ist nicht notwendig. In oben genanntem Fall kam es zu einer Restitutio ad integrum, sollte aber eine distale, ggf. langstreckige Harnleiterenge persistieren, können weitere Maßnahmen im Sinne einer offenen Operation mit Harnleiterneueinpflanzung in die Blase (z.B. Psoas-Hitch, Boari-Plastik) notwendig werden.
Male infertility affects 10% of couples and is treatable in many cases. The evaluation of infertility is initiated typically after 1 year of failure to conceive. Clinical evaluation of the infertile man requires a complete medical history, physical examination, and laboratory studies in order to identify and treat correctable causes of subfertility and recognize those who are candidates for assisted reproductive technologies, those who are sterile and should consider adoption or artificial insemination using donor sperm, and those who should undergo genetic screening. Although pregnancies can be achieved without any evaluation other than a semen analysis, this test alone is insufficient to adequately evaluate the male patient. Treatment of correctable male-factor pathology is cost effective, does not increase the risk of multiple births, and can spare the woman invasive procedures and potential complications associated with assisted reproductive technologies.
