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—Surgical incision sites for retroperitoneal (Palomo), inguinal (Ivanissevich), and sub-inguinal (Marmar ) approaches.
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In this article we reviewed the pathophysiology, diagnosis and treatment of varicoceles. The etiology and pathogenesis of varicoceles cannot be explained by one theory. Valve dysfunction, ontogenetic collateral formation and the nutcracker phenomenon seem to act synergistically. Hyperthermia, elevated hydrostatic pressure and antisperm agents are s...
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Aim: The aim of the study was to assess patient selection for embolization of varicoceles based
on ultrasonography. An additional objective of the work was to evaluate the results of endovascular
treatment. Material and methods: From January 2015 till August 2017, 53 patients
with varicoceles diagnosed in an ultrasound examination underwent endovas...
Citations
... Physical examination may or may not show a palpable varicocele, most of the time varicoceles are diagnosed only when patients present with infertility or adolescents during a physical examination [3]. Varicoceles are associated with various deleterious effects on testes like testicular hypotrophy, impairment in spermatogenesis mainly in the form of low or absent count, decreased sperm motility, and abnormal sperm morphology [4]. Oxidative stress, scrotal hyperthermia, hormonal disturbances, testicular hypoperfusion, hypoxia, and backfl ow of toxic metabolites are potential mediators of varicocele-mediated infertility of which oxidative stress has been implicated as the central mediator of varicoceleassociated infertility [5]. ...
Introduction: A varicocele is a vascular lesion characterised by dilatation and tortuosity of the veins of the pampiniform plexus and is found in approximately one-fifth of the adult male population. It is the most common cause of treatable infertility. Physical examination may or may not show a varicocele which is mostly diagnosed only when patients present with infertility or adolescents during a physical examination, like testicular hypotrophy, impairment in spermatogenesis mainly in the form of low or absent count, decreased sperm motility, and abnormal sperm morphology. Treatment for varicocele includes medical therapies, radiological embolization, and surgical techniques. Medical therapy, including antioxidants and anti-inflammatory agents, has been utilized with variable success. Radiological embolization of varicocele is a new technique in the treatment of varicocele, but it is associated with high recurrences and high cost. Varicoceles are surgically treated either by open or laparoscopic approaches the principal aim being occlusion of the dilated veins of the pampiniform plexus. A definitive conclusion of indication of medical treatment cannot be drawn at present because most published studies have inadequate design and lack controls. Various studies in the past have concluded significant changes in sperm parameters (total count, motility, morphology) post-varicocele repair. However, few other studies suggest no improvement in sperm parameters following surgical varicocele repair and studies that conclude recommendations against repair of varicocele. Thus, conflicting opinions have opened the scope to establish this fact by this study. Aim: To evaluate changes in sperm morphology, sperm count, and sperm motility in a patient with varicocele after varicocele surgery. Materials and methods: The study was conducted in the Department of Surgery, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi, India from August 2019 to February 2021. The sample size was calculated to be 50 using Slovin’s formula with a confidence level of 95% with a margin error taken as 5% (p - value 0.05). Sperm morphology, sperm count, and sperm motility were the parameters studied before and after 3 months of surgery. Results: The majority of patients belonged to the age group of 18 to 25 years (42%) followed by 26 to 35 years (40%) (27.78 ± 6.547 years). Left-sided varicocele was more common (54%), followed by bilateral varicocele (42%). Varicocele grade II was most common (58%) followed by grade I (30%) and lastly grade III (12%). Total sperm count improved by 8.88 million per ml after varicocelectomy. Total sperm motility improved by 6.08% after the surgery. Total normal sperm forms improved by 6.44% after varicocele repair. Conclusion: Based on the findings it was concluded that Varicocelectomy results in significant improvement in total sperm count, total sperm motility, and total normal sperm morphology. The best improvement was seen in sperm count followed by total normal sperm forms and lastly total sperm motility.
... Varicocele represents a common condition within the male population, arising at the adolescent age and becoming evident in the adult, 1,2 representing the first cause of male infertility. [3][4][5] Most cases occur on the left and are secondary to valvular lack or malfunctioning, 6 although other minor causes (e.g., the presence of aberrant communicating vessels) are advocated. 1 The main indication for treatment is the presence of pain (at any age), infertility in adult patients, 7 and testicular hypotrophy under 18 years of age (since a spermiogram is not obtainable in youngsters). ...
... 16 The options available for treatment of varicocele are surgery (ligation of the veins within the spermatic cord at the inguinal canal or the subinguinal area) or endovascular scleroembolization (antegrade or retrograde sclerotherapy). 4 Retrograde sclerotherapy represents nowadays the most used, effective, and safe percutaneous technique in the treatment of male varicocele and a valid alternative to surgery. 39 Via a common femoral, internal jugular, or humeral venous access, the spermatic vein is ...
Objectives:
the aim of our study is to compare the incidence of veno-venous shunts in male varicocele and evaluate the possibility to exclude them with manual compression or/and scrotal ligation in order to carry out the procedure of retrograde sclero-embolization.
Methods:
in our retrospective study all patients undergone retrograde sclerotherapy for varicocele in our Interventional Radiology Unit in the last four years were evaluated. Collaterals towards other venous shunts were identified and how many and which patients would be able to complete the procedure safely were considered.
Results:
of the 91 patients, as many as 22 (i.e., 24.17%) patients presented anatomical variants, consisting in shunting into left iliac vein (9 [9.89%]), lumbar left veins (3 [3.29%]), right iliac vein (1 [1.09%]), both iliac veins (1 [1.09%]), left femoral vein (1 [1.09%]) or a more proximal portion of the ISV itself without shunting (3 [3.29%]). Patients with duplication could benefit from a more distal injection in order to prevent back-flow; of the 19 left, nine successfully underwent sclerotherapy with manual compression or/and scrotal ligation, whereas in 10 flow through the collaterals could not be interrupted and patients were demanded for surgery.
Conclusions:
many patients with abnormal communications between the internal spermatic vein and the iliac veins (that is, shunts towards the iliac veins) may as well undergo retrograde sclerotherapy safely if compression/ligation is applied.
Advances in knowledge:
no large previous study highlighted the impact of veno-venous shunts in technical feasibility of retrograde sclerotherapy of varicocele.
... Although venography remains the gold standard for ISV reflux diagnosis, it can provide comprehensive information on the structural distribution of ISV. 9,10 Injection of a contrast may change the flow volume and pressure in the ISV system, which makes it difficult motility, sperm concentration, and morphology. The levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (T), and prolactin (PRL) were measured in each patient. ...
... Scrotal ultrasonography with Doppler color flow was performed before microsurgical varicocelectomy at the Department of Ultrasound, Shengjing Hospital of China Medical University. We used Toshiba Aplio 400 (Toshiba Medical System [China] Co., Ltd., Beijing, China), Toshiba Aplio 500 (Toshiba Medical System [China] Co., Ltd.), and a relevant high-frequency (6)(7)(8)(9)(10)(11)(12) linear probe (Toshiba Medical System [China] Co., Ltd.). The Valsalva maneuver was performed to create spermatic venous reflux, and the transverse plane was displayed to detect the distribution of the reflux signals. ...
The hemodynamic characteristics of venous reflux are associated with infertility in patients with varicocele; however, an effective method for quantifying the structural distribution of the reflux is lacking. This study aimed to predict surgical outcomes using a new software for venous reflux quantification. This was a retrospective cohort study of a consecutive series of 105 patients (age range: 22-44 years) between July 2017 and September 2019. Venous reflux of the varicocele was obtained using the Valsalva maneuver during scrotal Doppler ultrasonography before microsurgical varicocelectomy. Using this software, the colored reflux signals were segmented, and the gray scale of the color pixels representing the reflux velocity was comprehensively quantified into the mean reflux velocity of the green layer (MRVG) and the reflux velocity standard deviation of the green layer (RVSDG). Spontaneous pregnancy and changes from baseline in the semen parameters were assessed during a 12-month follow-up period. Data were analyzed using logistic regression analysis. An association of the high MRVG group with impaired progressive motility (odds ratio [OR] = 2.868, 95% confidence interval [CI]: 1.133-7.265) and impaired sperm concentration (OR = 2.943, 95% CI: 1.196-7.239) was found during multivariate analysis. High MRVG (OR = 2.680, 95% CI: 1.086-6.614) and high RVSDG (OR = 2.508, 95% CI: 1.030-6.111) were found to be independent predictors of failure to achieve pregnancy following microsurgical repair. In summary, intense venous reflux is an independent predictor of impaired progressive motility, sperm concentration, and pregnancy outcomes after microsurgical varicocelectomy.
... The anatomic differences between left and right internal spermatic vein drainage may be related to the different association between BMI and left and right varicocele. 24 'Nutcracker phenomenon' 5,10,12,25 is now widely accepted as one of the main theories to explain the possible association between BMI and left varicocele. 'Nutcracker phenomenon' suggests that varicocele is caused by increased pressure in the left renal vein as it is compressed between the aorta and the superior mesenteric artery, 5 while adipose tissue may reduce the compression. ...
Objectives:
To explore the relationship between body mass index and varicocele, the range of body mass index that leads to increased odds of varicocele, and the association between body mass index with the position and grade of varicocele.
Methods:
We conducted a cross-sectional study of 211 989 Chinese males aged 18-65 years participated in the National Free Pre-conception Check-up Projects from January 2013 to December 2018. Univariate and multivariate logistic regression models were constructed to assess the association between body mass index and varicocele.
Results:
Overweight and obese males had 13.1% (odds ratio 0.869, 95% confidence interval 0.838-0.902) and 32.3% (odds ratio 0.677, 95% confidence interval 0.632-0.725) lower odds of varicocele than those with normal body mass index, respectively. The association between them was non-linear, and males with body mass index of 17.74 to 23.09 kg/m2 had an increased odds of varicocele. The overweight and obese males had lower odds of left and bilateral varicocele, but the right varicocele odds was increased by 63.3% in obese males.
Conclusion:
Body mass index was associated with the odds of varicocele among reproductive-age males, but the odds varied by position. The effects of weight management and varicocele on fertility should be taken into account in fertility guidance.
... 4 Stres oksidatif -Konsentrasi ROS yang terlalu tinggi akan mengoksidasi asam lemak pada membran spermatozoa dan menyebabkan kerusakan DNA dengan fragmentasi sperma. 8 Varikokel yang tidak diterapi dengan baik dapat berkembang menjadi nyeri walaupun jarang terjadi. Mekanisme nyeri tersebut meliputi peningkatan suhu testis, tekanan vena yang lebih tinggi, stres oksidatif, ketidakseimbangan hormon, refluks metabolik toksik dari ginjal atau adrenal, hipoksia, serta kemungkinan peregangan serabut saraf di kordaspermatika kompleks varikokel yang berdilatasi. ...
... 19 Sedangkan kerugiannya, biaya lebih mahal, durasi operasi lama, membutuhkan anestesi umum dan rawat inap lebih lama daripada bedah mikro terbuka. 8 Varikokelektomi umumnya dilakukan secara transperitoneal. Tingkat persisten/ kekambuhan varikokelektomi laparoskopi sekitar 6-15%. ...
Varikokel merupakan dilatasi abnormal dan pembesaran sistem vena pleksus pampiniformis dan vena testis dengan refluks darah vena secara terus-menerus ataupun intermiten. Modalitas pencitraan dapat digunakan untuk konfirmasi diagnosis varikokel. Varikokel merupakan salah satu penyebab infertilitas pada laki-laki. Tata laksana yang tepat akan meningkatkan parameter semen. Varikokelektomi dengan teknik bedah mikro efektif dengan tingkat rekurensi dan komplikasi yang rendah. Varicocele is an abnormal dilatation and enlargement of the pampiniform plexus and testicular veins with continuous or intermittent venous reflux. Imaging modalities can confirm the diagnosis. Varicocele may cause male infertility; appropriate management may improve semen parameters. Varicocelectomy with microsurgical technique is effective with low recurrence and complication rate.
... Yukarda belirtilen nedenler sperm sayısında azalma, morfolojisinde bozulmaya ve sperm hareket bozukluğuna yol açar. Tüm bunlara rağmen adolesan varikosel cerrahi olarak tedavi edilebilir önemli infertilite nedenlerindendir (10,11). ...
... Genellikle varikosel sol tarafta da olmaktadır (4,5). İzole sağ varikosel oldukça nadir görülmekle birlikte mutlaka olgularda spermatik ven ya da vena kava basısına neden olabilecek renal kitle, retroperitoneal kitle ya da situs inversus totalis araştırılmalıdır (11). ...
... Tedavi Yöntemleri; Varikosel tedavisinde birçok yöntem tanımlanmakla birlikte sıklıkla cerrahi tedavi uygulanmaktadır (11)(12). Bu yöntemlerin ana amacı testiküler arteri ve lenfatikleri koruyarak dilate venlerin bağlanması ya da oklüze edilmesidir. ...
ÖZETVarikosel, adolesan yaş grubunda da erişkin yaş grubuna benzer sıklıkta görülmektedir. İnfertiliteye neden olabileceği için tanı ve tedavisinde dikkatli ve titiz olunmalıdır. Genel olarak adolesan varikosellerinde fertiliteyi korumak ve testis fonksiyonlarının korunması için yüksek derecede varikosel ya da testis volümünde % 20 azalma cerrahi endikasyon olarak kabul görmektedir. Bu nedenle adolesan varikoseli olan hastaların testis volümleri seri ultrason ölçümleri ve muayene ile yakından takip edilmelidir. Ergenlik döneminden sonra spermiyogram takibi de seri ultrason ölçümleri takipte önemli katkılar sağlar. Cerrahi tedaviden elde edilen başarı nedeniyle bu yaş grubunda tanısı oldukça önemlidir. Bu çalışma da adolesan varikosel tanı ve tedavisi incelenmiştir.
... Bu anormal venler, venöz sirkulasyonun bozulmasına, sürrenal kaynaklı metabolitlerin reflüsüne ve olumsuz testiküler ısı döngüsüne neden olmaktadır. Varikoselin testis üzerindeki bu olumsuz etkileri ilerleyici testis hasarı ve bozulmuş spermatogenez ile sonuçlanabilir [3,4]. Varikoselektomi, varikosel cerrahisinde en sık uygulanan tedavi yöntemidir. ...
Amaç:İnfertil erkeklerde varikoselektomi ameliyatının semen analizi ve gebelik üzerine etkilerini değerlendirmeyi amaçladık.
Yöntem: İki merkezde 2009-2014 yılları arasında, tek taraflı ya da bilateral mikroskopik varikoselektomi yapılan hastaların verileri retrospektif olarak incelendi ve kayıtları tam olan 180 hasta çalışmaya dahil edildi. Tüm hastalarda mikroskop ya da loop kullanılarak işlem gerçekleştirildi. Hastaların preoperatif ve postoperatif sperm parametreleri ve spontan gebelik oranları karşılaştırıldı.
Bulgular: Hastaların yaş ortalaması 29.6 (17-46) yıl idi. 99 (%55) hastada cerrahi sonrası spontan gebelik sağlanırken, 81 (%45) hasta yardımcı üreme yöntemleri için infertilite polkliniğine yönlendirildi. Sperm parametreleri irdelendiğinde, konsantrasyonunda düzelme saptanan hasta oranı %22.7; hareketlilikte (a+b) düzelmesaptanan hasta oranı %59.4; morfolojide düzelme saptanan hasta oranı oranı ise %51.1 olarak tespit edildi. (p<0.05)
Sonuç: Bu çalışma, literatür verileriyle uyumlu olarak varikoselektominin semen analizi ve gebelik üzerine olan olumlu katkısını ortaya koymaktadır.
... One of the main theories explaining the pathophysiology of varicocele is the theory of elevated testicular temperature [4]. However, the etiology of temperature rise in the standing and Valsalva maneuver positions has not still detected [5]. It should be noted that the increased intra-abdominal pressure is considered as a weak risk factor for varicocele [6]. ...
Introduction: A varicocele is the abnormal dilation and tortuosity of venous plexus above the testicles. The
pattern of abnormal heat distribution in the scrotum can be detected through thermal imaging, which is a
distant, non-contact, and non-invasive method. The aim of the present study is to detect and grade varicocele.
Materials and Methods: This study was conducted on 50 patients with high probability of varicocele,
who referred to a hospital affiliated to the AJA University of Medical Sciences, Tehran, Iran. The
evaluation procedure included thermal imaging, clinical diagnosis, and ultrasound test. The gold
standard method was based on ultrasound examination. The thermal imaging was performed using a
non-contact infrared camera.
Results: This paper presented two methods for diagnosing and grading varicocele. The first method
was based on the patterns and models of thermal asymmetry in the testicles (including three
asymmetric and symmetric patterns). The second method was based on the temperature differences.
The obtained results demonstrated that the use of temperature differences in the diagnosis of
varicocele was better than the other proposed method. In addition, a temperature difference of 0.5°C
in the pampiniform venous plexus was an important indicator for the diagnosis of varicocele using
thermal imaging. The accuracy of thermography in grading varicocele was 76%.
Conclusion: According to the results of the study, thermography is a useful method for initial
varicocele screening and can be applied as a supplement to other diagnostic techniques due to its low
cost and lack of radiation exposure. Thermography was concluded to be a precise technique for the
diagnosis of varicocele; however, its capability to determine the varicocele grading was comparatively
low.
... Although the etiology of varicocele is not well known, it is assumed that several factors such as functional insufficiency of venous valves draining the testicles and resulting reflux, oxidative stress, reflux of surrenal-derived metabolites, and dysfunction of the testicular temperature conversion system play a role in its pathophysiology (3,4). ...
Background/aim: We aimed to compare the results of unilateral and bilateral varicocele surgery.
Materials and methods: In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic
varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who
underwent bilateral and unilateral microscopic varicocelectomy.
Results: Te mean age was 29.6 (17–46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent
bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When
we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II.
Te rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. Te improvement rate in sperm morphology
was 46.3% in Group I and 56.1% in Group II. Tere were no signifcant differences between all these parameters.
Conclusion: In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy,
these results were not statistically signifcant. Improvement rates in sperm parameters were similar between the patients who underwent
unilateral and bilateral varicocelectomy
... This creates a condition of reflux and stasis of blood to the testicle. This is manifested in particular in the left testicle (95%) and rarely in the right testicle (5%) because of the different anatomical features between the two vascular pathways [5]. ...
