Varicocele complicating spontaneous arteriovenous fistula

We describe herein a rare case of a varicocele complicating spontaneous arteriovenous fistula. A 40‐year‐old man was referred to our hospital in November 2006, complaining of a non‐tender mass in the left scrotum at the age of 15 and thereafter. On examination, his left scrotum revealed a large varicocele, but no manifest superficial thrill was noted. Scrotal ultrasonograpy revealed approximately 7 cm large varicocele. Computed tomography angiography revealed the existence of an arteriovenous fistula between the left testicular artery and the veins of the left pampiniform plexus. We laparoscopically carried out internal spermatic vessels ligation under the diagnosis of a varicocele complicating a spontaneous arteriovenous fistula. The postoperative course was uneventful. At 18 months postoperatively, the varicocele and fistula had not recurred.     

Polyorchidism with varicocele: a case report and review of literature

Polyorchidism is defined as the presence of more than 2 histologically proven testes. We report the case of a 20-year-old man with polyorchidism, presenting with right scrotal pain and right scrotal ovoid mass. Scrotal examination revealed two ovoid, mobile lumps with testicular sensation in the right side of the scrotum. Scrotal colour Doppler ultrasonography and magnetic resonance imaging confirmed the presence of double testes with common epididymis and common vas. Microscopic varicocele ligation was performed, and then, two ipsilateral testes were sutured together. The testes were then returned to the scrotum with fixation.     

经皮小切口腹膜外超选择性精索静脉结扎和腹腔镜手术治疗精索静脉曲张的临床随机对照研究

目的：比较经皮小切口腹膜外超选择性精索静脉结扎和腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的效果。方法：将884例精索静脉曲张患者分成两组,A组为经皮小切口腹膜外超选择性精索静脉结扎组,810例;B组为腹腔镜下精索静脉高位结扎组,74例;比较两组的手术时间、术后住院天数、住院费用、症状缓解率、并发症发生率和精液质量改善率等。结果：两组平均手术时间、术后住院天数相似,差异无统计学意义（P〉0．05）;A组住院费用比B组少,差异有统计学意义（P〈0．05）;A组复发率及睾丸鞘膜积液、阴囊水肿和附睾肿痛等术后并发症发生率低于B组,差异有统计学意义（P〈0．05）;两组术后6个月精液质量改善率相似,差异无统计学意义（P〉0．05）。结论：经皮小切口腹膜外超选择性精索静脉结扎术属于微创手术,较腹腔镜下精索静脉高位结扎术具有复发率低、并发症少、住院费用低、疗效好和易推广等优点。     

Varicoceles: the diagnostic dilemma

Clinical examination of the scrotum remains the most commonly used technique to diagnose varicoceles. However, scrotal anatomy (eg, thick scrotum, scarring, hydrocele) in some men may make physical examination alone unreliable. In these situations, imaging (eg, ultrasound, Doppler imaging, venography) may be used to diagnose a varicocele. The dilemma is that there are no widely accepted or used criteria to diagnose a varicocele based on imaging. This paper reviews the different imaging techniques used and the accuracy of each in diagnosing a varicocele.     

隐匿式切口阴囊根部精索静脉曲张结扎术(附38例报告)

目的 探索改良精索静脉曲张(VAC)结扎术方法的效果.方法 采用阴囊根部皮纹小切口,应用2-6倍手术显微镜加罂粟碱注射液鉴别动静脉,结扎所有静脉,皮内缝合切口.结果 本组38例切口均I期愈合,切口瘢痕隐匿.术后6个月随访28例均未见复发,其中随访已婚精子质量异常者13例,精子质量改善者9例,改善率为69.2%.结论 隐匿式切口阴囊根部精索静脉结扎术具有一定的学术和临床应用价值.     

介入栓塞治疗精索静脉曲张的临床体会

目的观察经导管精索内静脉钢圈栓塞治疗精索静脉曲张的疗效。方法对16例精索静脉曲张患者进行经导管栓塞治疗,分析其疗效。结果16例患者经导管栓塞治疗后阴囊内容物缩小,阴囊坠胀感及疼痛等症状有不同程度的改善,精液质量明显提高,未出现严重的并发症。结论导管法钢圈栓塞治疗精索静脉曲张简单、经济、疗效满意,值得推广。     

改良Palomo术治疗儿童精索静脉曲张(附45例报告)

目的探讨改良Palomo术在儿童精索静脉曲张中的应用效果。方法1999年6月～2005年1月，对45例精索静脉曲张患儿行高位腹膜后径路手术，即改良Palomo术。结果术后阴囊下坠感消失，无出血、血肿、慢性疼痛及睾丸萎缩、阴囊水囊肿等并发症发生，无复发病例。39例双侧阴囊恢复等大，6例患侧阴囊略大，但蚯蚓状团块消失。结论改良Palomo术治疗儿童精索静脉曲张疗效确切，并发症少，值得推广应用。     

Intra-testicular varicocele presenting as acute scrotum

The term varicocele describes a dilated, tortuous and elongated pampiniform plexus of veins, which is well known in relation to the spermatic cord. Recently varicocele has also been observed inside the testis, and this new entity is known as intra-testicular varicocele. We present a case of intra-testicular varicocele presenting as acute scrotum and discuss the management issues.     

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.     

Bilateral Varicocele: Impact of Right Spermatic Vein Ligation on Fertility

The most frequent cause of male infertility is left varicocele. The surgical or laparoscopic approach for spermatic vein ligation is considered the best method of treatment. The approach to a clinically significant left varicocele associated with a right varicocele (frequently of a smaller size) is not univocal. We analyzed the seminal responses obtained in 65 patients with bilateral varicocele (grades 2 to 3 on the left side and grade 1 on the right side) assigned randomly to undergo unilateral or bilateral ligation. There were no significant differences between the 2 groups with regard to seminal recovery.     

Intratesticular varicocele in adolescents: a reversible anechoic lesion of the testis

PURPOSE: We describe ultrasonographic and clinical findings in adolescents with intratesticular varicocele. MATERIALS AND METHODS: Three adolescent boys 12 to 16 years old each had a large intratesticular multicystic lesion on scrotal Doppler ultrasound for a large extratesticular varicocele. The presence of active Doppler flow within the anechoic lesions supported the diagnosis of intratesticular varicocele. RESULTS: All 3 boys underwent spermatic vein ligation for varicocele. In each case scrotal Doppler ultrasound at 3 months postoperatively demonstrated resolution of the intratesticular anechoic lesions and Doppler flow, confirming the diagnoses of intratesticular varicocele. CONCLUSIONS: Intratesticular varicocele is a clinically occult lesion that may occur in conjunction with extratesticular varicocele. This entity is apparent on scrotal Doppler ultrasound as an intratesticular anechoic lesion with active Doppler flow, and has been shown to resolve following spermatic vein ligation. Its clinical significance has not yet been defined.     

OUTCOMES OF VARICOCELE LIGATION DONE FOR PAIN

Purpose

Surgical ligation is an option in the management of patients with painful varicocele. Little objective data exist addressing the effectiveness of this treatment. We reviewed records from 58 patients who underwent varicocele ligation at our institution from January 1985 to May 1996 to establish success of surgical ligation of the painful varicocele.

Materials and Methods

ICD-9 billing codes were used to identify all patients who had undergone varicocele ligation for pain since 1985. We documented patient age, grade and location of varicocele, duration and quality of pain, response to conservative therapy and surgical approach to ligation. Telephone interviews and chart reviews were conducted to determine resolution of pain, complications of the procedure and if the patient would choose surgery again.

Results

We obtained followup on 35 of the 58 painful varicocele patients (60%). Average patient age was 25.7 years (range 15 to 65). The varicocele was on the left side in 30 men and bilateral in 5. Of the patients 31 described the pain as a dull throbbing ache, 2 as sharp and 2 as a pulling sensation. Initial conservative therapy failed in all 35 men. Varicocele was grade III in 18 cases, grade II in 16 and grade I in 1. The inguinal or subinguinal approach was used in 24 patients, high ligation in 10 and laparoscopic repair in 1. In 30 patients there was (86%) complete resolution of pain postoperatively and 1 had partial resolution. Only 4 patients (11%) had persistent or worse symptoms.

Conclusions

This retrospective review supports the conclusion that varicocele ligation is an effective treatment for painful varicocele in properly selected patients.     

经脐单孔腹腔镜精索内静脉高位结扎术(附24例报告)

目的 探讨经脐单孔腹腔镜在精索内静脉高位结扎手术中的应用. 方法 24例精索静脉曲张患者,均行经脐单孔腹腔镜精索内静脉高位结扎术,其中单纯左侧15例,双侧9例. 结果 24例患者手术均取得成功,单侧手术时间平均(42.3±10.2)min,双侧手术时间平均(58.4±9.7)min,术中出血量平均(15.4 ±5.2)ml.无中转开放手术,术中无肠管损伤、睾丸动脉误扎,术后无穿刺口出血、感染,无阴囊血肿,无腹壁穿刺处疝形成.术后6个月复查精液常规,精子密度计数及精子活率较术前明显提高(P＜0.01或P＜0.05). 结论 经脐单孔腹腔镜行精索内静脉高位结扎术治疗精索静脉曲张是安全可行的,随着器械的不断改进和完善,单孔腹腔镜手术具有更广阔的发展前景.     

显微镜辅助下精索静脉曲张结扎术与腹腔镜下精索静脉曲张结扎术疗效分析(附60例报告)

目的 比较显微镜辅助下经外环口精索静脉曲张结扎术与腹腔镜精索静脉结扎术治疗精索静脉曲张的疗效差异.方法 60例精索静脉曲张合并精液质量异常患者,随机分为两组,经外环口显微镜辅助下精索静脉结扎术组(显微镜组,30例)和腹腔镜精索静脉结扎术组(腹腔镜组,30例),两组手术前各指标差异无统计学意义.比较两组手术时间、住院费用、住院天数、术后并发症的发生、精液质量的变化.结果 两组在手术时间、术后住院天数、住院费用、术后腹胀、阴囊肿胀均具有显著性差异(P＜0.05),术后复发、术后附睾炎、睾丸萎缩、术后精液质量变化无显著性差异(P＞0.05).结论 经外环口位置行显微镜下精索静脉结扎术治疗精索静脉曲张是一种安全、有效、简便、经济及便于推广的手术治疗方式.     

Reversal of testicular growth failure by varicocele ligation

A total of 20 male patients 11 to 19 years old had a grade 2 or 3 varicocele and volume loss of the testis ipsilateral to the varicocele. None of these patients presented because of subfertility. Following varicocele ligation a significant increase in volume of the testis ipsilateral to the varicocele was observed in 16 of 20 patients. All 20 patients have been followed for 1 to 6 years. Our results suggest that a moderate to large varicocele can be responsible for testicular growth retardation and that early ligation of the varicocele may reverse this process.     

Varicocele treatment: prospective randomized trial of 3 methods.

This study was done to evaluate the surgical results and the impact on fertility potential of 3 methods of varicocele treatment. Consecutive varicocele patients with primary or secondary infertility were randomly assigned to 3 treatment groups. Of the patients 36 underwent percutaneous embolization, 55 high ligation of the internal spermatic vein and 28 transinguinal simultaneous ligation of the internal and external spermatic veins. The transinguinal ligation proved to be safe. There was no difference in pregnancy rates but the seminal variables showed a slight improvement with statistical significance only in the 2 open surgical methods. There were no surgical failures in the transinguinal group as opposed to the other 2 techniques. Transinguinal ligation of the internal and external spermatic veins may be recommended as the primary treatment for varicocele. This technique also seems to be the procedure of choice when repeat intervention is required for failure of high ligation or embolization.     

Clinical study of varicocele by sequential scrotal scintigraphy: Klinische Analyse mit sequentieller Skrotalszintigraphie der Varikozele

Sequential scrotal scintigraphy was used to study testicular blood flow in 122 patients with clinically diagnosed varicocele. The sensitivity of scrotal scintigraphy was 91.7% on the whole sequential images. The late-phase image was superior in sensitivity to that of the early-phase images. The difference in time between the arrival of radioactivity in the iliac artery and in the pampiniform plexus grew shorter with increasing grade of varicocele. Time-activity curves were classified into four patterns. One type (Type 3), which was more frequently observed in grade II and grade III varicocele than grade I varicocele, showed a decreased arterial perfusion of the left side lesion. It is concluded that scintigraphic analysis using both sequential images and time-activity curves is not only highly representative of the grade of clinically palpable varicocele, but also provides a better understanding of local hemodynamics in the scrotum.     

Clinical outcome of microsurgical varicocelectomy done for pain

Surgical ligation for varicocele is primarily used in the management of male infertility patients. However, effectiveness of the ligation for painful varicocele is still controversial. We reviewed record s from 18 patients (average age 17.8 years) who underwent varicocele ligation done for pain at our institution from June 1999 to May 2010. The varicocele was on the left side and was grade III in 15 cases and grade II in 3 cases. The pain was classified into three types ; discomfort, dull pain and sharp pain. Microsurgical varicocelectomy was done with inguinal or subinguinal approach. Evaluation of postoperative pain was available in 17 patients, and 15 patients (88%) reported complete resolution of the pain with averaged follow up duration of 11 months (3 to 53 months). We concluded that microsurgical varicocelectomy using the inguinal or subinguinal approach was an effective treatment modality for varicocele-associated pain.     

Predictors of success in surgical ligation of painful varicocele

INTRODUCTION: Surgical ligation is used in the treatment of painful varicocele. We conducted this retrospective study to establish the effectiveness of varicocele ligation for the treatment of pain and to examine the factors that might predict outcomes. PATIENTS AND METHODS: Eighty-three patients underwent varicocele ligation for pain during the study period. Review of medical records and postal questionnaires were used to document patient age, grade and location of varicocele, duration and quality of pain, surgical approach, complications and the resolution of pain. RESULTS: Follow-up was available for 68 (82%) patients. In 76.5% patients there was marked or complete resolution of pain and 14 had partial resolution. Only 9% patients had persistent pain and 1.5% patient reported worsening pain. The quality of pain, dull ache or dragging, was the only factor that correlated with the resolution of pain following surgery. CONCLUSIONS: Surgical ligation is an effective treatment for the painful varicocele. The quality of pain at presentation may predict outcomes in selected patients.     

Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches

AIM: The standard management of varicocele repair is the subject of ongoing controversy. We retrospectively evaluated three surgical methods of varicocele treatment to determine the minimally invasive and most effective procedure. METHODS: We performed 144 varicocelectomies on infertile patients with left clinical varicocele. Of the patients, 50 were treated with retroperitoneal high ligation under lumbar anesthesia, 33 with laparoscopic ligation under general anesthesia, and 61 with subinguinal microscopic ligation under local anesthesia. Operative time, hospital days, and clinical outcomes were compared between these techniques. RESULTS: The operating time and hospitalization period required for subinguinal microscopic ligation was signi fi cantly shorter compared to those for the other procedures. All patients treated with subinguinal microscopic ligation could achieve normal activity as soon as they returned to their rooms. Postoperative complications were observed in fi ve (10.0%) cases treated with high ligation and three (9.1%) laparoscopic cases, but were not observed after the subinguinal procedure. There were six cases (12.0%) of recurrence in the high ligation group and six (6.1%) in the laparoscopic group, but none in the subinguinal group. Sperm density was signi fi cantly improved in all procedures postoperatively, but sperm motility was not improved. The two-year pregnancy rate calculated by the Kaplan-Meier method was 35.8% for high ligation, 40.4% for laparoscopic ligation and 50.9% for subinguinal microscopic ligation, although there were no statistical differences between the three groups. CONCLUSION: We concluded that subinguinal microscopic varicocelectomy could be a minimally invasive procedure compared to the other two techniques and a worthy method for treating male infertility due to clinical varicocele.