Induction of varicocele in the dog: I. Partial ligation of the left renal vein does not induce a varicocele in the dog

Induction of varicocele was attempted by partial ligation of the left renal vein in 10 male dogs. The effects on sperm count, sperm motility, and sperm morphology, as well as on hemodynamics, were assessed. Furthermore, testicular, vascular, and kidney morphology was studied. Changes in the diameter and consistency of the left spermatic cord were found to be temporary. Total sperm count, sperm motility, and the total number of oval forms were not significantly altered. Hemodynamic studies revealed a renocaval pressure gradient, but retrograde flow in the distal part of the left testicular vein could not be observed by arteriography. A collateral network was found to compensate for the restricted left renal vein. Histologic examination revealed no damage to the seminiferous epithelium. Changes were not found in the kidney and left pampiniform plexus. Although some temporary changes induced by the partial ligation of the left renal vein are suggestive of varicocele, this hemodynamic study shows that the presented dog model does not mimic varicocele as encountered in man.     

Effects of surgical repair of first degree varicocele on gonadal function and testicular atrophy

Varicocele is one of the main causes of male infertility. This pathology, in fact, is responsible for progressive anatomical and functional testicular damage. Constant monitoring of subjects suffering from varicocele is therefore necessary. In the present study, we evaluated the effect of varicocele surgical treatment on seminal parameters, testicular growth and pregnancy rate in patients with grade I varicocele. We operated on 47 patients with left grade I varicocele associated with sperm abnormalities and with testicular hypotrophy. A high ligation of the internal spermatic vein and all its collaterals was performed in all patients. The postoperative follow-up showed a significant improvement in seminal parameters (motility, morphology and sperm count) and in testicular volumes. Moreover, a pregnancy rate of 58% was observed. These results confirm the observations of other investigators and suggest that surgical therapy of varicocele is capable of improving seminal parameters, of reversing varicocele-related testicular hypotrophy and of achieving high pregnancy rates even in patients with grade I varicocele.     

Surgical repair of secondary right varicocele in rats with primary left varicocele: effects on fertility, testicular temperature, spermatogenesis, and sperm maturation.

To evaluate whether or not dilation of the right testicular vein is a constant finding in animals with left varicocele and to illustrate its contribution to the detrimental effect of a left varicocele on the right testis, an experimental varicocele model was produced in 40 rats. Ten other rats had a sham operation (group A). Seven weeks after the operation, all 50 rats underwent laparotomy and dilation of both testicular veins was seen in 23 rats, which were randomly assigned to group B (n = 11) and group C (n = 12). One week later, groups A and C underwent sham ligation of the right testicular vein, whereas group B rats underwent resection of this vein. At 84 days after the initial operation, group C rats showed a significant reduction in right epididymal sperm content, motility, and fertilizing capacity, right testicular weight, and right testicular vs. intraabdominal temperature difference when compared with groups A and B. Since surgical repair of the secondary right varicocele improved all the parameters indicating the harmful consequences of the primary left varicocele on the right testis, it appears that dilation of the right testicular vein contributes to the detrimental effect of a left varicocele on the right testis.     

Improvement of semen characteristics after surgical repair of bilateral testicular varicocele as compared to unilateral varicocele patients

The operative treatment for surgical repair of bilateral testicular varicoceles was evaluated in terms of the improvement achieved in the sperm density and percentage progressive motile sperm. These parameters were compared for 27 cases of bilateral varicocele diagnosed by palpation and subjected to bilateral high ligation of the internal spermatic vein and for 40 cases of left unilateral testicular varicocele. There were no significant differences in preoperative values (such as sperm density; progressive motile sperm; serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and Johnson's score count) between the bilateral and unilateral testicular varicocele groups. The improvement in postoperative sperm density in the cases with bilateral testicular varicocele was apparently less satisfactory than in the cases with testicular varicocele only on the left side.     

Factors affecting fertility after varicocelectomy

We performed high ligation of the internal spermatic vein in 27 cases of left varicocele with disturbance of spermatogenesis, and studied postoperative fertility. The results indicated that the cases were divided into three groups, namely group I in which pregnancy occurred after ligation: group II in which the sperm count increased but no pregnancy occurred, and group III in which there was no improvement in the sperm count. The age, size of varicocele, preoperative volume of bilateral testicle, bilateral testicular histologies, serum LH, serum FSH, peak responded value after LH-RH administration, plasma testosterone and response after HCG administration were evaluated. We detected that the volume of bilateral testicles, bilateral testicular histologies, serum FSH and the response after LH-RH administration served as good indicators for postoperative evaluation of fertility.     

Left testicular artery arching over the ipsilateral renal vein

Aim:To report two cases of the left testicular artery arching over the left renal vein(LRV)before running downwardto the testis.Methods:The subjects were obtained from two Japanese cadavers.During the student course ofgross-anatomical dissection,the anatomical relationship between the testicular vessels and the renal vein was specifi-cally observed.Results:The arching left testicular artery arose from the aorta below the LRV and made a looparound the LRV,which appeared to be mildly compressed between the arching artery and the psoas major muscle.Conclusion:Clinically,compression of the LRV between the abdominal aorta and the superior mesenteric arteryoccasionally induces LRV hypertension,resulting in varicocele,orthostatic protenuria and hematuria.Consideringthat the incidence of a left arching testicular artery is higher than that of a right one,an arching left artery could be anadditional cause of LRV hypertension.(Asian J Androl 2006 Jan;8:107-110)     

Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome

OBJECTIVE: To investigate the anatomic and hemodynamic properties of testicular venous drainage and its effects on varicocele formation and reflux using color Doppler ultrasound (US) with emphasis on renal vein entrapment syndrome. MATERIAL AND METHODS: Upper abdominal and scrotal US examinations of 35 varicocele patients and 35 healthy male subjects were performed in the supine position during rest, during a Valsalva maneuver and in the erect position. The aortomesenteric angle and distance (AMA and AMD, respectively), peak mean velocities (PVs) and diameters of different segments of renal veins, testicular vein diameters and duration of flow inversion were measured. RESULTS: In the varicocele group, the lateral segment of the left renal vein (LRV) had a larger diameter and slower PV, and the medial segment of the LRV had a smaller diameter and faster PV. The diameter of the dominant draining vein correlated with the PV of the medial and lateral segments of the LRV, whereas there was no correlation between the diameter of the dominant draining vein and the diameters of the right renal vein (RRV) and the lateral segment of the LRV or the PV of the RRV. The duration of flow inversion correlated with the diameter and PV of the medial segment of the LRV. No correlation between the diameters and PVs of the RRV and the lateral segment of the LRV was detected. CONCLUSIONS: The decreases in the AMA, AMD, diameter of the medial segment of the LRV and PV of the lateral segment of the LRV, and the increases in the PV of the medial segment of the LRV and the diameter of the lateral segment of the LRV in varicocele patients in all positions suggest the entrapment or impingement of the left renal vein between the aorta and the superior mesenteric artery. This has been defined as the "nutcracker phenomenon", which is known to affect varicocele formation.     

Low-grade left varicocele in patients over 30 years old:the effect of spermatic vein ligation on fertility

OBJECTIVES: To evaluate the effect of spermatic vein ligation in patients over 30 years old and with low-grade left varicocele, and thus help to establish whether such patients might benefit from surgery. PATIENTS AND METHODS: A randomized study was conducted on 68 infertile patients (30-38 years old) with evidence of sperm abnormalities and who had low-grade varicocele (grade I according to Hirsch), comparing left spermatic vein ligation with no treatment. The outcome was assessed by standard sperm analysis and eventual paternity. RESULTS: There was no improvement in sperm quality in either of the groups one year after surgery, and no significant difference in paternity. CONCLUSIONS: Left spermatic vein ligation for low-grade varicocele in patients more than 30 years old cannot be recommended.     

Effects of surgical repair of experimental left varicocele on testicular temperature, spermatogenesis, sperm maturation, endocrine function, and fertility in rabbits.

To evaluate the effectiveness of surgical correction of varicocele in restoring the function of the varicocelized testicle, experimental varicoceles were created in 16 male rabbits by partly ligating the left lumbotesticular trunk. Five control rabbits received a sham operation (group A). Two months later, eight of the varicocelized rabbits underwent surgical repair by ligation and cutting of the dilated left testicular vein (group B). The remaining eight varicocelized animals did not receive any additional treatment (group C). Five months after the initial operation, group C animals had a significantly lower sperm concentration, sperm motility, bilateral testicular androgen-binding protein activity, bilateral testicular vein testosterone concentration, bilateral testicular versus intraabdominal temperature difference, and fertility when compared with groups A and B. These findings suggested that the surgical repair of an experimental varicocele in the rabbit can significantly improve the parameters indicating the harmful effects of the varicocele on the testicles.     

不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的疗效分析

目的探讨不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的临床疗效。方法回顾性分析郑州大学第一附属医院在2015年7月至2018年9月期间诊治的胡桃夹综合征所致左侧精索静脉中重度曲张患者的临床资料。56例患者共分为3组,24例患者行显微镜下左侧精索静脉低位结扎术+精索外静脉剥离切除术为低位结扎组;19例患者行开放性左侧精索静脉高位结扎术为高位结扎组;13例患者左侧精索静脉中重度曲张并有血尿和/或蛋白尿,行腹腔镜下左肾静脉外支架固定术+生殖静脉结扎术,为血蛋白尿组。术后随访6~30个月,平均(11.5±6.5)月,患者于术前及术后6个月复查阴囊彩超及精液分析,对比精索静脉直径和精液恢复情况。结果①3组患者组内比较:精索静脉直径术后显著小于术前,精子浓度、精子活率术后显著高于术前,差异均有统计学意义(P均<0.01);组间比较:精子浓度3组间术前术后差异均无显著性统计学意义(P均>0.05);而精索静脉直径低位结扎组优于其他2组,精子活率的提高低位结扎组优于其他2组,差异均有统计学意义(P均<0.05)。②血蛋白尿组患者术后随访血尿、蛋白尿症状消失,左肾静脉受压状况明显改善,低位结扎组、高位结扎组左肾静脉受压状况无明显改善。结论显微镜下左侧精索静脉低位结扎术是治疗胡桃夹综合征所致左侧精索静脉中重度曲张的一种姑息、有效的手术方式。     

Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading

We aimed to assess the effect of spermatic vein ligation on seminal total antioxidant capacity (TAC) in patients with varicocele. Twenty infertile male patients with varicocele and 20 normal fertile men (control group) were included in the study. All the male patients were diagnosed with primary infertility and varicocele. The patients with varicocele were divided into two groups as nonpalpable (GI) (eight patients) and palpable (GII-III) (12 patients) varicocele groups. All the patients underwent microsurgical spermatic vein ligation. Seminal TAC levels and sperm parameters were evaluated in all the patients. Preoperative sperm count, sperm motility, sperm morphology and seminal TAC levels with equivalent figures 3-6 months after spermatic vein ligation and the same values of the control group were compared. There was a statistically significant increase in the total seminal antioxidant capacity level after spermatic vein ligation, and there was a statistically significant increase in the sperm count, sperm motility and spermatozoa with normal morphology. However, evaluation of the patients for varicocele grade showed a statistically significant increase in the TAC level only in the GII-III varicocele group. Spermatic vein ligation can improve the total seminal antioxidant capacity levels especially in patients with middle and high grade varicocele.     

Repair of experimental varicoceles in the rat. Long-term effects on testicular blood flow and temperature and cauda epididymidal sperm concentration and motility

The effects of varicocele and varicocele repair on testicular blood flow, temperature, sperm counts, and sperm motility were assessed in adult male rats. The duration of the experimental varicocele and the varicocele repair were three and two times as long, respectively, as that studied previously. Varicoceles were created by partial ligation of the left renal vein and repairs were accomplished by high ligation of the left spermatic vein. Testicular blood flow was determined by using the radiolabeled microsphere technique. Testicular temperature was taken via needle probe thermometer. Sperm samples were obtained by micropuncture of the cauda epididymidis, and were counted on a hemacytometer and observed for motility under the light microscope. Varicoceles were studied 100 days after their creation. Repairs were performed on varicoceles that had lasted 100 days and the animals were studied 60 days after repair. Mean testicular blood flow (ml/100 g tissue/min) was significantly increased (P less than 0.05) in animals with varicocele (left testis (LT) = 42.2 +/- 1.1, right testis (RT) = 39.1 +/- 1.2) when compared with normal controls (LT = 29.3 +/- 1.6, RT = 29.6 +/- 1.7), animals with varicocele repair (LT = 30.7 +/- 1.3, RT = 30.0 +/- 1.6), or sham-operated animals (LT = 29.7 +/- 1.4, RT = 31.1 +/- 1.4).(ABSTRACT TRUNCATED AT 250 WORDS)     

显微镜下三种手术入路治疗精索静脉曲张的探索

目的对比分析显微镜下三种手术入路治疗精索静脉曲张的临床效果。方法回顾性分析2017年3月至2019年2月于苏州大学附属第二医院行精索静脉结扎术的88例患者资料,所有患者均在显微镜下行精索静脉结扎术,手术由同一组医师完成。根据手术入路的不同分为三组,Ⅰ组经腹膜后切口(n=14),Ⅱ组经腹股沟切口(n=48),Ⅲ组经外环口下切口(n=26),比较三组患者的手术时间、结扎静脉数量、复发率、精液质量的改善情况、视觉模拟评分法(VAS)及术后短期并发症。结果Ⅲ组手术时间、结扎静脉分支数量明显多于Ⅱ组(P<0.05);三组患者术后精液质量均优于术前(P<0.05);术后VAS评分均低于术前评分(P<0.05)。但是,三组患者短期并发症的发生率、复发率、阴囊疼痛缓解程度、精子活力与形态改善情况进行组间比较,差异无统计学意义(P>0.05)。结论三种显微镜下精索静脉结扎术均能改善患者精液质量、缓解阴囊疼痛。临床上,应根据患者的实际情况选择合适的手术入路完成手术,以获得好的临床疗效。     

Effects of aescin on testicular repairment in rats with experimentally induced varicocele

This study was conducted to investigate the effects of aescin treatment in a rodent model treated with an experimentally induced varicocele. Experimental varicocele was induced by partial ligation of the left renal vein of rats. Aescin administration was performed daily for 4 weeks after the varicocele induction. Seven weeks later, a contrast‐enhanced ultrasound was performed of the rats' testis to assess testicular blood flow. The animals were sacrificed, and H&E staining was then used to evaluate testicular pathological changes and polymorphonuclear leucocytes density. Cauda epididymal sperm counts and motility were evaluated. Blood was collected for the measurement of follicle‐stimulating hormone, luteinising hormone and testosterone. Contrast‐enhanced ultrasound showed that there were significant decreases in testicular blood flow in the aescin‐treated groups compared with those in control varicocele group. Testicular oedema was detected in those rats treated with a varicocele but without aescin, while no oedema was found in the experimental group. H&E staining showed dysfunctional spermatogenesis in both cohorts; however, polymorphonuclear leucocytes density was significantly reduced in aescin‐treated groups. There was an increase in sperm counts of the aescin‐treated groups. Our study demonstrated that aescin could exert therapeutical effects on reversal of testicular lesions in varicocele rats.     

Varicocele

Approximately one third of infertile men present with varicocele, while the incidence among males in the general public is approximately 15 per cent. The etiology may be a longer left spermatic vein with its right-angle insertion into the left renal vein and/or absence of valves, which causes a higher hydrostatic pressure in the left spermatic vein causing dilatation. The nutcracker phenomenon is also a possible etiology. Much of the pathophysiology is still unknown, but increased blood flow causing an elevated intratesticular temperature may be of significance. Though there are many recent reports on the importance of a subclinical varicocele, we are not convinced of its significance. The best method for diagnosis remains a good clinical examination. The incidence of adolescents with varicocele is about the same as men with varicocele (approximately 15 per cent). Adolescents with varicocele should be treated if the testicular mass is decreased or if they are symptomatic. Surgical ligation is still the preferred method of treatment. Percutaneous treatment of varicoceles has an approximately 11 per cent incidence of minor complications and an occlusion rate of 73 per cent with a recurrence rate of 5 per cent. We reserve percutaneous treatment for recurrent varicoceles after surgical ligation, but primary percutaneous therapy is a reasonable approach.     

Treatment in male infertile clinic of Kaizuka Municipal Hospital

The results of treatment of 68 idiopathic male infertile cases are reported. The follow up period was 3 years and 8 months from the time the Department of Urology, Kaizuka Municipal Hospital had opened. The main treatments were human mammary gonadotropin-human chorionic gonadotropin (HMG-HCG) therapy and high ligation of left testicular vein in the cases accompanied with varicocele. Adjuvant therapy was administration of vitamin B12, herb medicine and antibiotic agents for prostatovesiculitis. Some cases were administered clomiphene citrate. The results in 43 cases at over 10 weeks after treatment was followed. Mean sperm count and mean sperm activity rate in 11 cases accompanied with no varicocele and whose sperm count was 2 approximately 45 x 10(6)/ml were raised from 11.0 +/- 8.0 SD x 10(6)/ml and 19.1 +/- 11.4 SD% to 22.7 +/- 16.8 SD x 10(6)/ml and 26.9 +/- 18.5 SD%, respectively after 20 weeks of HMG-HCG therapy. Efficacy was 7 out of 11 (63.6%) in sperm count and 6 out of 11 (54.5%) in sperm activity rate. Pregnancy was obtained in 3 cases. Effect of HMG-HCG therapy was not observed in 8 cases accompanied with varicocele and whose sperm count was 2 approximately 45 x 10(6)/ml. High ligation of left testicular vein was effective in all of the 4 cases accompanied with varicocele and whose sperm count was 2 approximately 45 x 10(6)/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Recurrences, testicular growth and semen parameters after laparoscopic Palomo varicocelectomy

The aim of this study was to evaluate the influence of laparoscopic Palomo varicocelectomy on testicular volume and sperm parameters. Laparoscopic Palomo varicocelectomy was performed on 91 patients for left-sided grade II and grade III varicoceles. Ultrasound-derived testicular volumes, semen volume, sperm concentration, percentage sperm motility and total motile sperm count were compared before and after the procedure. Postoperative complications and recurrence rate were also assessed. There were no surgical complications. Four patients (5%) had a mild hydrocele, but did not need hydrocelectomy. No patients presented signs of testicular atrophy and the left testicular volume increased in the adolescents (p < 0.05), but not in the adults. Our data suggest that laparoscopic high mass ligation of both the testicular artery and vein is a highly effective, reliable method for the treatment of varicocele. It is associated with very low complication and recurrence rates and with an objective improvement in fertility parameters.     

Hemodynamics of the varicocele. Part II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography

Left renal vein compression occurring mainly with the patient in the upright position, and being less severe or absent in the supine position, was considered to be the main cause of varicoceles. We show that left renal vein compression is, indeed, more severe with the patient in the upright than in the supine position and that it produces a left renocaval pressure gradient that is responsible for the retrograde blood flow in the left testicular vein. This pressure gradient, which was determined in the supine and semierect positions in 34 patients, increased from a mean of 3.8 mm. Hg in the supine position to a mean of 7.8 mm. Hg in the semierect position. On the basis of the assumption that the renocaval pressure gradient measured with the patient in the semierect position determines the presence and velocity of a retrograde flow in the left testicular vein, as shown by the dynamic portion of the varicocele scintigram (see part I), these variables were analyzed and the correlation coefficient proved to be good. Therefore, we conclude that the varicocele occurs when the left testicular vein lacks valves or there is a renogonadal bypass, and the severity of the left renal vein compression in the (semi) upright position determines the velocity of the retrograde flow in the left testicular vein and the size of the varicocele.     

Alteration of semen quality in dogs after creation of varicocele.

A left vein varicocele was created in male dogs by partially obstructing the left renal vein medial to the entrance of the left internal spermatic vein. Eight dogs had semen parameters determined preoperatively (2 times/week for five weeks) and postoperatively (2 times/week for twelve weeks). Semen quality was altered by the experimental varicocele. A significant decrease in sperm count, motility, per cent viable, and per cent oval sperm were noted. Semen volume was not affected. The possible chemical influence of serotonin is mentioned. Testosterone levels were unchanged by the varicocele. Histologic findings in the left and right testicles are mentioned before and after creation of the varicocele.