Structure of the venous wall of the pampiniform plexus in idiopathic varicocele

The Authors discuss about some histologic patterns observed in 100 pampiniform plexus specimens of patients who underwent direct scrotal surgery for idiopathic varicocele. Tunica media was involved in all of 81 specimens in which Authors observed a vascular wall thickening. Out of these, localized hypertrophic phenomena, leading to segmental vascular obliteration, prevailed (74%) on widespread forms (26%). In advanced focal localizations subintimal fibrous pads were demonstrated. In 96% of cases hypertrophy affected the muscular layer too, respectively in focal (41%) and diffuse (59%) way. In 85% of cases fragmentation of lamina elastica interna was associated to media hypertrophy. In 69%, venous lumen was dilated, frequently in association with wall thickening, while only in 12 specimens all vascular layers were reduced. Occlusive endoluminal thrombi were evident in 12%. At last the Authors underline how the wall pathologic modifications do not involve all the veins within the same plexus, and stress on the possible physiopathologic relationships between this fact and different haemodynamic and clinic conditions.     

ACP1 genetic polymorphism and spermatic parameters in men with varicocele

Platelet‐derived growth factor (PDGF) and its receptors (PDGFRs) play a key role in the regulation of the embryonic and postnatal development of male gonads. PDGF deficiency is associated with severe spermatogenic impairment. ACP₁ is a phosphoprotein tyrosine phosphatase that is able to dephosphorylate PDGFR, decreasing its activity as growth factor. The enzyme is polymorphic and shows strong differences in enzymatic activity among genotypes. At the Outpatient Department for Infertility, University of Rome La Sapienza, we investigated the effect of high‐activity ACP₁ genotype on spermatic parameters in 105 subjects referred to for varicocele. ACP₁ genotype was determined by DNA analysis. In ACP₁ *B/*C genotype, which shows the highest enzymatic activity, spermatic concentration is significantly lower and atypical spermatozoa are significantly more frequent as compared to other ACP₁ genotypes. It is concluded that subjects carrying *B/*C genotype who represent about 10% of the population have a severe impairment of spermatic parameters in the presence of varicocele.     

Comparison of spermatic vein histology in patients with and without varicocele

The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P < 0.001). No significant differences were detected regarding the tunica adventitia and tunica media thicknesses when patients with grade 2 varicocele were compared with patients with grade 3 varicocele (P > 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.     

Semen cahracteristics before and after ligation of the left internal spermatic veins in men with varicocele.

The semen from 20 men with varicocele was studied before and after surgical correction of the varicocele. The effect on sperm quality was only marginal and could not explain the fairly high conception rate (20%) after operation. The recommendation that varicocele in men with long-term infertility should be eliminated by ligation of the internal spermatic veins is still justified despite the absence of positive effects on sperm quality.     

Importance of lateral inspection of the scrotum and value of intraoperative spermatic phlebography in varicocele

Varicocele appearing on the posterior surface of the scrotum is apt to be overlooked in a routine physical examination. Lateral inspection of the scrotum is important to detect a varicocele of this type. Intraoperative spermatic phlebography on high ligation for varicocele was valuable in confirming the ligation of a single vein or in visualizing the vessel(s) left unligated.     

Morphology of spermatozoa in infertile men with and without varicocele

This study was carried out to evaluate the morphology of spermatozoa in infertile men with and without varicocele. A series of 285 ejaculates were fully evaluated for seminal volume, sperm count, motility, and morphology, and classified into fertile (165 subjects), infertile without varicocele (93 subjects) and infertile with varicocele (27 subjects). Sperm morphology was classified by multiple entry criteria and recorded as normal, abnormal with head, midpiece, or tail single anomaly or abnormal with simultaneous multiple abnormalities. Semen volume was almost identical in the three groups. Among the infertile men, sperm count was lower in those having a varicocele, but conversely those with varicocele had a higher percentage of motile spermatozoa, higher percentage of spermatozoa with forward movement and higher sperm velocity. There were higher proportions of spermatozoa with abnormal morphology, total number of anomalies, and multiple anomalies in infertile men, both with and without varicocele, than in fertile men. The percentage of abnormal spermatozoa was higher in infertile men with varicocele than in those without varicocele. The pattern of sperm morphology differed between the infertile and the fertile group, and with the presence or absence of varicocele. In the presence of varicocele, only the incidence of elongated (tapered) forms was significantly increased.     

精索静脉曲张不育者的精索静脉血气分析及其意义

本文对２０例精索静脉曲张致不育症患者和１０例已生育的精索静脉曲张患者在行左精索静脉高位结扎术中，同时取左精索静脉及周围静脉血作血气分析比较，并与患者术前精液分析对照。发现两组的术中精索静脉血与周围静脉血ＰＯ２（氧分压）、ＳａＯ２（血氧饱和度）、ＰＣＯ２（二氧化碳分压）、ｐＨ及其它指标没有显著性差异（Ｐ＞０．０５）。患者精索静脉血中有ＰＯ２下降、ＳａＯ２下降、ＰＣＯ２上升等变化，与精索静脉曲张致男性不育精液检查所表现出的不同程度的精子数减少、活动率降低、畸形精子比例增加等变化没有必然联系（Ｐ＞０．０５）。初步分析其临床意义认为：精索静脉曲张中的睾丸血流动力学改变以及血气平衡失调致不育的假说，即精索静脉血淤滞和睾丸组织缺氧在精索静脉曲张所致不育中的作用，在本临床研究中没有得到验证。     

Scrotal temperature and semen quality in men with and without varicocele

The exact role of varicocele in human male infertility remains controversial. Fifty-five male partners of infertile couples randomly selected and 17 fertile semen donors were evaluated for semen quality, scrotal temperature, and presence of varicocele using clinical palpation and Doppler ultrasound. The incidence of varicocele was 42% in male partners of infertile couples and 41% in fertile semen donors. Left scrotal temperature was significantly (p less than .001) higher in infertile males with varicocele as compared to all groups. No significant differences were observed in the percentage of morphologically normal sperm in semen of males with and without varicocele. However, the incidence of tapered, elongated, and immature sperm was significantly higher in the infertile patient population with a varicocele. Measurement of scrotal temperature and assessment of sperm morphology may be used as predictors of the presence and deleterious effect of varicocele.     

精索静脉曲张不育患者精囊内静脉血中活性氧和抗氧化剂的关系(英文)

目的:以外周静脉血作为比较对象,评估精囊内静脉血中活性氧(ROS)和抗氧化剂的关系。方法:观察对象为68名患有精索静脉曲张的少弱精患者。在腹股沟的曲张精索静脉切除术中,提取精囊内血液样本和中央尺骨静脉血样本。分别测定这些血液样本中的三种 ROS(丙二醛[MDA]、双氧水[H_2O_2]、一氧化氮[NO])和四种抗氧化剂(过氧化岐化酶[SOD]、过氧化氢酶[Cat]、谷胱甘肽过氧化酶[GPx]、维生素 C)。结果:精囊内静脉血样内的 ROS 因素的平均值明显高于外周血中的值(MDA 18.7±1.4 nm/mL vs.15.4±1.4 nm/mL,H_2O_2 43.6±8.0 Um/mL vs.30.8±8.1 Um/mL,NO 2.3±0.5 nm/L vs.1.6±0.4nm/L,P<0.01)。而精囊内静脉血的抗氧化剂的平均值明显低于外周血中的值(SOD 1690.7±130.0 U/mL vs.1818.5±143.0 U/mL,Cat 38.9±6.1 mm/mL vs.47.9±10.2 mm/mL,GPx 20.4±8.1 U/mL vs.23.0±8.4 U/mL,维生素 C 0.3±0.1 vs.0.4±0.1 mg/dL,P<0.05)。结论:患有精索静脉曲张不育男性的精囊内静脉血相对于外周静脉循环,具有更高的 ROS 和更低的抗氧化剂。     

Seminal plasma hormone profile in infertile men with and without varicocele

Seminal plasma FSH, LH, prolactin, testosterone, and oestradiol were estimated in 41 infertile men with varicocele and 45 infertile men without varicocele who failed to impregnate their wives after 2 years of marriage and 30 fertile men. There was significant elevation of FSH in the seminal plasma of the infertile men with varicocele compared with the seminal plasma of the other infertile and fertile men. Seminal LH and prolactin values were similar in both infertile groups but significantly higher than in the fertile men. Testosterone and oestradiol levels in the seminal plasma of infertile men with varicocele were lower than in the fertile and the other infertile males. Finding that both steroids were decreased in infertile men with varicocele could explain disturbed function of spermatozoa in men with varicocele. Further analysis will elucidate the importance of these hormone findings in the seminal plasma of infertile men with varicocele.     

Clinical studies of varicocele. 3: A rare venous return via Santorini's plexus in a varicocele patient. Report of a case

A 12-year-old man was referred to our clinic because of sanguineous discharge. At the out-patient department, bilateral varicocele was found. Urinalysis showed microscopic hematuria, but no other laboratory data were abnormal. Excretion urography was normal. The retrograde phlebograph showed a rare venous return via Santorini's plexus and lumbar veins. After varicocelectomy, urinalysis improved.     

Semen and reproductive hormone parameters in fertile men with and without varicocele

Although varicoceles are a widely accepted identifiable male factor in infertile couples, the benefit of varicocele repair in improving pregnancy and live birth rates remains uncertain. The Study for Future Families obtained semen and reproductive hormone samples from US men whose partners were currently pregnant. In our analysis cohort of 709 men, a varicocele was detected by clinical examination in 56 (8%) of men. Men with varicocele had smaller left testis, and lower total and total motile sperm counts than men without varicocele. Gonadotropin levels were higher as well in men with varicocele. Interestingly, testosterone levels were also slightly higher in men with varicocele. Despite these differences, there was no difference between the groups in the time to achieve the study pregnancy or percentage of men with a previous pregnancy. We conclude that even in fertile men, varicoceles are associated with some degree of testicular hypofunction. This would support current recommendations to consider varicocele repair in male partners in infertile couples who demonstrate both a varicocele and abnormal semen parameters and after evaluation for treatable female factors.     

alpha-1,4-Glucosidase activity in infertile oligoasthenozoospermic men with and without varicocele

This work aimed to assess seminal alpha-1,4-glucosidase activity in infertile oligoasthenozoospermic men associated with and without scrotal varicocele. Eighty men were investigated. They were divided into three groups: group 1 (n = 20), fertile normozoospermic men; group 2 (n = 30), oligoasthenozoospermia with varicocele; and group 3 (n = 30), oligoasthenozoospermia without varicocele. The patients underwent medical history, clinical examination, conventional semen analysis and estimation of seminal plasma alpha-1,4-glucosidase activity by double-beam spectrophotometer method and serum testosterone by radioimmunoassay method. There was a significant decrease in the mean seminal alpha-1,4-glucosidase activity levels in infertile men versus controls (mean +/- SD; 7.66 +/- 0.433, 2.088 +/- 0.565, 5.384 +/- 0.85 mU ml(-1) respectively). Mean serum testosterone levels demonstrated nonsignificant differences between studied groups. Seminal alpha-1,4-glucosidase activity levels demonstrated significant correlation with sperm count, sperm motility percentage and serum testosterone in oligoasthenozoospermia with varicocele group and demonstrated nonsignificant correlation in other groups. It is concluded that varicocele-induced hypoxia is the adverse effect that causes both oligoasthenozoospermia and decreased seminal alpha-1,4-glucosidase levels.     

Varicocelectomy: incidence of external spermatic vein involvement in the clinical varicocele.

The vascular anatomy of the clinical varicocele, and the incidence of involvement of the external spermatic vein were studied. Dilation of the external spermatic vein (4 mm) was found in 49.5 percent of 93 varicoceles in 67 patients. The location of this vein, its potential involvement in a varicocele, and its management were reviewed.     

Clinical studies of varicocele. 2: Radiographic examination and measurement of spermatic vein pressure in varicocele patients

There are two types of internal spermatic veins (ISV) by radiographic examinations. In type 1, ISV is dilated with some collateral venous branches. On the other hand, ISV of type 2 is narrowed with increased collateral venous branches or abnormalities such as the circumaortic renal are seen. In these groups, pressure of renal vein and ISV were measured. As a result, renal vein pressure was about the same in type 1 as in the controls at 9.5 +/- 2.3 cmH2O but was higher in type 2 at 17.0 +/- 2.8 cmH2O. As for ISV, it was also about the same in type 2 as in the controls at 13.9 +/- 6.8 cmH2O but was markedly higher in type 2 at 33.3 +/- 3.9 cmH2O. When selective renal venography was performed, a contrast medium back-flow was seen in 9 out of 11 type 1 varicocele patients, but it was not seen in any of the cases with the nutcracker phenomenon. These results suggested that type 1 may be caused by the structural and functional disorders in the valve between the renal vein and ISV. In contrast, pathogenesis of type 2 varicocele may be due to an abnormality of the ISV in the embryo.     

Reproductive history and semen analysis in prevasectomy fertile men with and without varicocele

A group of 598 allegedly fertile men requesting vasectomy were investigated; varicocele was found in 97 (16.2%) of these men. The mean ages and age distributions of men with and without varicocele were not significantly different. Reproductive histories (number of pregnancies, living children and spontaneous abortions, as well as incidence of present pregnancy) were similar in both groups. The average seminal characteristics (semen volume, sperm count, total sperm count, percentage of motile spermatozoa, quality of motility, morphology) were not different for men with and without varicocele, except for a slight, but significantly higher incidence of oval-headed sperm in men without varicocele. However, the incidence of varicocele was significantly higher in men with sperm counts below 40 million/ml. Three important observations may be made from this study: 1) the incidence of varicocele in this prevasectomy population was similar to that reported for the general population, but lower than the incidence reported for male partners of infertile couples; 2) in this population of allegedly fertile men, the presence of a varicocele did not significantly affect reproductive performance; 3) even though the incidence of varicocele was higher in men with sperm counts below 40 million/ml, the average seminal characteristics were not different in men with and without varicocele.     

Venous outflow of the leg: Anatomy and physiologic mechanism of the plantar venous plexus

Purpose: Mechanisms of venous outflow from the leg and foot have not been clearly defined. The purpose of this study was to evaluate the anatomy and physiologic mechanism of the plantar venous plexus and its impact on venous drainage from the tibial veins.Methods: Fifty phlebograms that contained complete foot and calf films were reviewed. On lateral films, the number of veins in the plantar venous plexus and its tibial outflow tract were counted. The length and diameter of the longest vein in the plantar venous system and the length of the foot arch were measured. The ratio of the length of the plantar venous plexus to the arch length was calculated. The presence or absence of valves within the plexus was recorded. Plantar venous plexus outflow was evaluated by an duplex ultrasonographic scan of the posterior tibial, anterior tibial, and peroneal veins during intermittent external pneumatic compression of the plantar surface of the foot.Results: The plantar venous plexus was composed of one to four large veins (mean, 2.7 veins) within the plantar aspect of the foot. The diameter of these veins was 4.0 ± 1.2 mm. The veins coursed diagonally from a lateral position in the forefoot to a medial position at the level of the ankle, spanning 75% of the foot arch. Prominent valves were recognized within the plantar veins in 22 of 50 patients. The plexus coalesced into an outflow tract of one to four veins (mean, 2.5 veins) that flowed exclusively into the posterior tibial venous system. Small accessory veins that drained the plantar surface of the forefoot flowed into either the posterior tibial or peroneal veins. This pattern of selective drainage of the plantar venous plexus was confirmed by duplex imaging. Mechanical compression of the plantar venous plexus produced a mean peak velocity in the posterior tibial veins of 123 ± 71 cm/sec, in the anterior tibial veins of 24 ± 14 cm/sec, and in the peroneal veins of 29 ± 26 cm/sec.Conclusions: The plantar venous plexus is composed of multiple large-diameter veins that span the arch of the foot. Compression of the plantar venous plexus, such as that which occurs during ambulation, is capable of significantly increasing flow through the posterior tibial venous system into the popliteal vein. Its function may be integral to venous outflow from the calf and priming of the more proximal calf muscle pump. (J Vasc Surg 1996;24:819-24.)