Total ligation of the left renal vein in the dog: an inappropriate model for varicocele

Induction of varicocele was attempted by ligation of the left renal vein (LRV) in male dogs (Group I). Before the operation and in the 4-month post-operative period, sperm count, sperm motility, and sperm morphology of Group I (n = 8) dogs were compared to sham operated animals (Group II, n = 5). Furthermore, haemodynamics as well as testicular and vascular morphology were studied. In Group I, changes in diameter and consistency of the spermatic cord were temporary. Semen quality was reduced significantly during the second month after ligation of the LRV, but improved thereafter. Haemodynamic studies revealed that LRV blood pressure was increased significantly in Group I dogs. An extensive venous collateral network replaced the occluded LRV. Retrograde blood flow in the left testicular vein (LTV) was observed only in the proximal part of the LTV of Group I dogs. In Group II dogs numerous pairs of sufficient valves prevented reflux into the LTV. Histological examination revealed that spermatogenesis was not impaired and that the left pampiniform plexus had not changed. The number of Leydig cells was decreased slightly in Group I dogs. Sufficient valves in the LTV prevented formation of a permanent varicocele.     

Varicocle in oligospermic patients: pathophysiology and results after ligation and division of the internal spermatic vein.

We have followed for up to 32 months 51 oligospermic patients with varicoceles who underwent high ligation and division of the left spermatic vein. Of these patients 59.9 per cent had improvement in total sperm count, 47.1 per cent in sperm motility and 42.1 per cent in the morphological pattern of the spermatozoa. Pregnancies were reported by 13 patients. Improvement in sperm motility occurred first, followed by improvement in morphology. The last improvement was in total sperm count. We suggest that the observation period after a varicocele operation be restricted to 9 months, in which time about 75 per cent of the expected improvement takes place. A clinical classification for the degree of varicocele is proposed. No correlation between size of the varicocele and treatment results could be observed. A classification of sperm analysis is proposed, using a 3-digital index that might enable better comparison of sperm analysis and better communication among physicians. We could not define a specific group of oligospermic patients who might benefit more than other groups from a varicocele operation. Pathophysiological pathways leading to impaired spermatogenesis in patients with varicoceles are discussed.     

Varicocele and antisperm antibodies

Semen analysis and immunofluorescent antisperm antibodies were tested in 65 patients with varicocele. The mean sperm count and motility values in our study were 36.8 +/- 2.9 million per ml and 38.4 +/- 2.5 per cent, respectively. Both parameters were found not to differ significantly in three grades of varicocele. Immunofluorescent antisperm antibodies were detected in 24.6 per cent of the cases. A significant correlation was demonstrated between the presence of the antibodies and genital infection.     

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.     

Experimental model of varicocele

The purpose of this investigation was to create a varicocele model in animals and to study the subsequent alterations in testicular physiology. The study comprised 22 dogs divided into 2 groups: test and control. In the test group (17 dogs), excision of a longitudinal strip of the fasciomuscular tube of the spermatic cord was done on one side only. In the control group (5 dogs), the spermatic cord was exposed without interference with the tube. Testicular temperature was measured, and biopsies from the 2 testicles and semen specimens were examined. Re-examination for variceal changes was performed in 3 dogs at the 4th postoperative week; in 3 dogs at the 6th, and in 16 dogs (11 test and 5 control) at the 8th postoperative week. Sections from spermatic cord and testicle were examined microscopically. Serum levels of testosterone follicle-stimulating hormone, luteinizing hormone and prolactin were assayed preoperatively and at the time of re-examination. Manifest varicocele was detected in 16 of 17 detubated dogs. It was huge in all dogs re-examined after 8 weeks. Semen showed decreased sperm count in all test animals except 1. The animals with induced varicocele had higher testicular temperature than the controls. Microscopically, the detubated spermatic cords have shown variceal changes and the testicle degenerative changes in all the test animals. Similar changes were encountered in the contralateral testicle in the animals re-examined at 8th week. Radioimmunoassay showed a significant decrease of serum testosterone and increase of prolactin postoperatively. Follicle-stimulating hormone and luteinizing hormone showed no significant change from the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Somatic angiotensin converting enzyme in varicocele

The ACE is found as two isozymes in the body. A somatic isozyme found in blood and several other tissues, and a testis-specific isozyme found only in developing spermatids and mature sperm. In this study, we investigated the ACE activity in left spermatic vein blood samples of infertile patients with varicocele and its correlation to spermatologic parameters. The somatic ACE activities were determined in the peripheral and left spermatic vein blood samples from 31 infertile patients who underwent variococelectomy, and 11 fertile control subjects underwent left inguinal herniorraphy. The somatic ACE activity was measured by kinetic spectrophotometric assay. Semen analyses were performed according to WHO guidelines. The mean somatic ACE activities of peripheral and left spermatic veins of the varicocele group were 60.3 +/- 23.0 and 60.2 +/- 23.2 U/L, respectively. In control group, peripheral and left spermatic vein ACE activities were found as 56.8 +/- 17.1 and 56.5 +/- 15.5 U/L, respectively. There was no significant difference between the ACE activity in peripheral and left spermatic vein blood sample from the varicocele and control group. There was no statistically significant correlation between the spermatologic parameters and ACE activities in the spermatic and peripheral vein in both of varicocele and control groups. As a result, it may be suggested that the somatic ACE has no causative role in pathophysiology of varicocele and varicocele related infertility.     

Varicocelectomy and infertility

Eighty males with varicocele underwent internal spermatic vein ligation as therapy for infertility. Semen quality improved in 78 per cent following ligation, and 51 per cent of wives became pregnant. The results in this series compare favorably with previous studies. We believe that spermatic vein ligation is a very successful adjunct in the treatment of the infer-tile male with 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.     

Varicocelectomy: 986 cases in a twelve-year study

Over a twelve-year period, surgical correction of varicocele was performed on 986 selected subfertile men. They were followed up for at least two years after surgery. Semen quality was improved in 70 per cent, and 53 per cent of the wives became pregnant. Statistically, the results were better in terms of semen quality improvement and pregnancy for patients who had preoperative sperm counts over 10 million per milliliter (85 per cent improved, 70 per cent pregnancy rate) than for patients who had preoperative sperm counts of less than 10 million per milliliter (35 per cent improved, 27 per cent pregnancy rate). The empirical use of postoperative human chorionic gonadotropin therapy in this latter group improved results significantly (55 per cent improved, 45 per cent pregnancy rate).     

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.     

精索静脉曲张不育患者的精液质量和精子形态学观察

目的:观察不育伴精索静脉曲张(VC)患者的精液质量和精子形态学变化。方法:98例不育伴VC患者精液按WHO标准常规分析并对精子形态学进行评价。130例正常供精者精液检测结果作为对照。结果:VC患者正常形态精子和前向运动精子明显低于对照组(P<0.001),精子畸形的类型以梨形、锥形和不定型头部畸形为主。结论:VC可导致精子畸形率升高,后者可能是男性生育力受损的重要标志之一,经染色后的精子形态学分析是判定VC患者精子受损的一个敏感指标。     

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)     

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。     

Predictive parameters of successful varicocele repair

A total of 130 men presenting with oligospermia and clinically identifiable scrotal varicoceles was evaluated, treated surgically and followed for 1 year for pregnancy rate. The treatment outcome was compared to an age-matched cohort of 83 oligospermic men who had received empirical medical therapy with clomiphene citrate (25 mg. per day) for the same 1-year interval. This study was done to contrast treatment modalities in infertility and not as a strict control. Only eugonadotropic patients in both groups were used for comparison. In the varicocele group the over-all pregnancy rate was 38.5 per cent. Four variables (a lack of testicular atrophy, sperm density greater than 50 million per ejaculate, sperm motility 60 per cent or more and serum follicle-stimulating hormone values less than 300 ng. per ml.) proved to be accurate preoperative predictors of postoperative pregnancy success. Four other variables (varicocele size and laterality, sperm forward progression greater than 2 and normal sperm morphology 60 per cent or more) did not yield statistically significant rates of improvement in pregnancy postoperatively. The pregnancy rate of the eugonadotropic patients undergoing varicocele repair was 45.8 per cent. Despite statistical similarity in patient age, sperm density and mean gonadotropin levels the medically treated patients had a pregnancy rate of only 25.5 per cent, significantly lower than the surgically treated patients. In summary, patients with an identifiable varicocele had a greater chance of achieving a pregnancy following surgical correction than did those treated with empirical drug therapy. In addition, certain preoperative variables in the physical and laboratory analyses appeared to portend a greater surgical response.     

精索静脉曲张不育症患者精索静脉血气分析

目的 探讨精索静脉曲张（varicocele,VC）导致男性不育的具体发病机制.方法 选择50例VC不育症患者及40例对照组作为研究对象,分别取其左侧精索内静脉以及周围静脉血进行血气分析,然后比较.结果 （1）VC不育症患者左侧精索静脉血中的PH、PO2、SO2及HCO3-低于外周静脉血（P＜0.05）,PCO2及K＋高于外周静脉血（P＜0.05）,而其他指标差异无统计学意义（P＞0.05）.（2）VC不育症患者左侧精索静脉血中的PH、PO2、SO2及HCO3-低于对照组（P＜0.05）,40例对照组PCO2及K＋高于对照组（P＜0.05）,而其他指标差异无统计学意义（P＞0.05）.（3）VC不育症患者精液密度及活率低于对照组（P＜0.05）,畸形率高于对照组（P＜0.05）.结论 VC不育症患者精索静脉中的PH、PO2、SO2、HCO3-降低和PCO2、K＋升高是导致精液密度及活率降低同时畸形率升高进而引起男性不育的原因.     

精索静脉曲张患者精液质量及其不育患者手术前后精液变化的观察

目的观察精索静脉曲张（VC）患者的精液质量和精子形态学改变，以及VC不育患者手术前后精液的变化。方法121例VC患者精液按WHO标准常规分析并对精子形态学进行评价，23例健康男性精液检查结果作为对照。并对21例VC不育患者术前及术后的精液进行检测分析。结果121例VC患者的精子密度、（A＋B）级活动力精子（％）、活率、有效精子数、活动精子数、活力指数以及正常形态精子比例较对照组明显降低（P〈0．01）；畸形精子中小头、锥形头和无定形头精子数较对照组增多（P〈0．01）。21例VC不育患者手术后精子质量和精子形态学较术前明显改善。结论VC可以引起精液质量下降导致不育，精子形态学分析是判定VC患者精子受损的一个敏感指标，手术能有效地改善精液质量。     

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)     

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.     

Varicocele sclerotherapy improves serum inhibin B levels and seminal parameters

The usefulness of treating varicocele in order to improve fertility is still a matter of debate. The aim of this study was to evaluate variations in seminal parameters and inhibin B concentrations in a group of males affected by varicocele and treated by percutaneous retrograde sclerotherapy in comparison with a group of patients who did not undergo varicocele treatment. Thirty-eight patients with left varicocele underwent spermatic vein phlebography and percutaneous retrograde sclerotherapy with hydroxy-polyaethoxy-dodecanol. Serum inhibin B, follicle-stimulating hormone (FSH), testosterone levels and seminal parameters (sperm concentration, motility and morphology) were performed before and 6 months after sclerotherapy. Forty patients with left varicocele who did not undergo sclerotherapy were studied as controls. A significant increase (p < 0.01) in serum inhibin B levels and a significant decrease (p < 0.05) in FSH levels were observed 6 months after treatment. Semen analysis showed a significant improvement in sperm concentration (p < 0.05) and progressive motility (p < 0.01) after treatment. In control group no significant variations in hormonal and seminal parameters were observed 6 months after the basal examination. Six months after the basal evaluation, inhibin B levels were significantly higher in treated subjects than in controls (p < 0.05) whereas FSH levels were significantly lower (p < 0.05). Sperm concentration and progressive motility were significantly increased (p < 0.05 and p < 0.001, respectively) in treated subjects in comparison with controls. In conclusion, varicocele sclerotherapy improves inhibin B levels and seminal parameters, confirming the positive effect of this treatment on spermatogenesis and Sertoli cell function.     

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.