Testicular blood flow in peripubertal and older rats with unilateral experimental varicocele and investigation into the mechanism of the bilateral response to the unilateral lesion

Testicular and reference organ blood flows and testicular temperatures were determined in peripubertal and mature rats with and without experimental left varicocele (ELV). Testicular blood flow and temperature were significantly increased bilaterally 30 days after surgery to induce unilateral varicocele, and this was the case in both the younger and older animals. It has not previously been known that the pathophysiological effects of ELV extended to the peripubertal testis. Previous experiments have demonstrated that the left testis is not necessary for the right testicular response to varicocele. In the present paper, animals were subjected to left orchiectomy simultaneously with the surgery to induce ELV. Thirty days later, the animals were divided into those with and those without the left spermatic vein varicosity. Testicular blood flow was determined in all these animals as well as in a separate group of control and experimental varicocele animals. The group of ELV animals with left spermatic varicosity demonstrated a significant increase in contralateral testicular blood flow while the ELV group without left spermatic varicosity did not. We speculate that left venous distention is involved in the mechanism for the contralateral response to unilateral varicocele.     

Varicocoele and saphenofemoral reflux: are they coincidentally related?

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It has been proposed that there is a significant relation between varicocoele and saphenofemoral reflux. Our results show that there is no statistically significant relation between varicocoele and saphenofemoral reflux.

OBJECTIVE

• ? To determine whether a relation between varicocoele and venous insufficiency at the level of the saphenofemoral junction (SFJ) is present.

PATIENTS AND METHODS

• ? A total of 100 patients with varicocoele and 50 age‐matched controls seen in the outpatient urology clinic were included in our prospectively designed survey. Patients with a history of scrotal, inguinal or vascular surgery were excluded from the study.
• ? Following a physical examination by the same urologist, coloured Doppler ultrasonography of the pampiniform plexus and the SFJ were performed by the same radiologist. Patients who had spermatic veins greater than 3.0 mm in diameter and reversed blood flow in Doppler ultrasonography were included in the study group.
• ? The competence of the SFJ was evaluated and retrograde venous flow for longer than 0.5 s was noted as positive for saphenofemoral incompetence.

RESULTS

• ? The mean age of varicocoele patients and the control group was 22.9 and 23.7 years, respectively. There were 83 patients with left varicocoele, five patients with right varicocoele and 12 patients with bilateral varicocoele.
• ? In the varicocoele group, 36 (36%) patients had saphenofemoral reflux while 64 (64%) had no reflux, whereas corresponding figures for the control group were 13 (26%) and 37 (74%) respectively (P= 0.32).
• ? There were 39 (46.9%) patients with a maximal vein diameter less than 3.6 mm (median 3.1 ± 0.3 mm) while there were 44 (53.1%) patients with a maximal vein diameter over 3.6 mm (median 4.1 ± 0.37 mm) (P= 0.20).

CONCLUSION

• ? There is no statistically significant relation between varicocoele and SFJ insufficiency. Varicocoele may not be attributable to a systemic vascular insufficiency; however, further comprehensive series with larger populations are required

     

Reduction of neoreflux after correctly performed ligation of the saphenofemoral junction. A randomized trial.

BACKGROUND: Neoreflux at the sapheno-femoral junction (SFJ) is an important cause of recurrent great saphenous varicose veins. This study compares four surgical methods of ligating the SFJ with the aim to reduce the rate of neoreflux. METHOD: In a prospective study, 379 patients (500 SFJ ligations) were randomised to one of four surgical procedures at the SFJ (125 groins each). In group A (control group) the SFJ was ligated in standard fashion with Vicryl (absorbable ligature); in group B, after Vicryl ligation continuous Prolene (non-absorbable) was sutured over the stump endothelium to prevent any contact with surrounding tissue; in group C. SFJ ligation was done with Ethibond (non-absorbable); in group D Ethibond ligation was followed by Prolene oversewing. The final study group included 114 patients (152 groins) who were all known to be free from recurrent groin reflux 3 months postoperatively and had colour duplex venous imaging 2 years after operation. RESULTS: Duplex imaging identified neoreflux at the SFJ in 10 out of 114 groins after 2 years (7%). There were differences in the rates between the four groups: Group A 3/31 (10%), Group B 0/32, Group C 5/44 (11%) and Group D 2/45 (4%). Neoreflux was significantly reduced in the two groups with endothelial closure (B and D): 2/70 (3%) versus 8/75 (11%, p<0.025). CONCLUSION: Recurrent reflux in the groin was reduced by over sewing the ligated SFJ in patients having varicose vein surgery. This adds weight to the theory of neovascularisation as a cause of recurrent veins and offers a means to reduce clinical recurrence rates.     

Decrease in apoptosis of germ cells in the testes of infertile men with varicocele

To determine whether the regulation of apoptosis in the testes of patients with varicocele testes was abnormal, affecting germ-cell differentiation and sperm production, we studied apoptosis in the testes of normal men and infertile men with varicocele. In all, 56 testicular biopsy specimens were collected from 28 varicocele patients. The specimens from the testes of five normal volunteers with informed consent were used as controls. In situ end-labeled cells were counted with a CAS 200 image analyzer, and an apoptotic index (AI) was calculated by division of the number of labeled cells by the total number of spermatocytes and spermatogonia in over 20 seminiferous tubules. The apoptosis was also examined by electron microscope. The mean AI was 9.67 ± 0.93% in normal testes (n = 5). In contrast, the mean AIs determined in the right and left testes of varicocele patients (n = 28) were 3.90 ± 2.28% and 3.78 ± 2.87%, respectively. The AIs recorded for the testes of varicocele patients were significantly lower than those noted for normal men (P < 0.05). In varicocele patients the AI obtained in the right testis was not statistically significantly different from that found in the left testis. The numbers of apoptotic cells per Sertoli cell also decreased in the testes of varicocele patients as compared with normal men (P < 0.01). Evaluation of all specimens, including the normal controls, revealed no significant correlation either between the AI and the sperm concentration on the seminogram or between the AI and Johnsen's mean score. There was also no relationship between the AI and the serum level of follicle-stimulating hormone, lutenizing hormone, testosterone, or estradiol. In conclusion, apoptosis is decreased in germ cells in the testes of infertile men with varicocele as compared with normal men.     

Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique.

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. We describe a microsurgical technique of varicocelectomy that significantly lowers the incidence of these complications. The testicle is delivered through a 2 to 3 cm. inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under the operating microscope. The testicular artery and lymphatics are identified and preserved. All internal spermatic veins are doubly ligated with small hemoclips or 4-zero silk and divided. The vas deferens and its vessels are preserved. Initially, we performed 33 conventional inguinal varicocelectomies in 24 men without delivery of the testis or use of a microscope. Postoperatively, 3 unilateral hydroceles (9%) and 3 unilateral recurrences (9%) were detected. For the next 12 cases 2.5x loupes were used resulting in no hydroceles but another recurrence (8%). We then performed 640 varicocelectomies in 429 men using the microsurgical technique with delivery of the testis. Among 382 men available for followup examination from 6 months to 7 years postoperatively no hydroceles and no cases of testicular atrophy were found. A total of 4 unilateral recurrent varicoceles (0.6%) was identified. The differences between the techniques in the incidence of hydrocele formation and varicocele recurrence are highly significant (p < 0.001). No wound infections occurred in any men. Four scrotal hematomas (0.6%), 1 of which required surgical drainage, occurred in the group with microsurgical ligation and delivery of the testis compared to none with the conventional technique. Preoperative and postoperative semen analyses (mean 3.57 analyses per patient) were obtained on 271 men. The changes in sperm count x 10(6) cc (36.9 to 46.8, p < 0.001), per cent motility (39.6 to 45.7%, p < 0.001) and per cent normal forms (48.4 to 52.10%, p < 0.001) were highly significant. The pregnancy rate was 152 of 357 couples (43%) followed for a minimum of 6 months postoperatively. Delivery of the testis through a small inguinal incision provides direct visual access to all possible avenues of testicular venous drainage. The operating microscope allows identification of the testicular artery, lymphatics and small venous channels. This minimally invasive, outpatient technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele recurrence.     

Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study.

Venous anatomy of the testis was reexamined by retrograde spermatic venography during surgery in 17 men with and in 11 without a varicocele. The route of venous drainage of the testis was the internal spermatic vein and the external pudendal vein. The cremasteric and vasal veins were smaller collaterals. There was no cross communication between the right and left spermatic venous systems in the scrotal, retropubic or pelvic areas. In men with a varicocele the spermatic venous plexus was formed of numerous venous sinuses and large dilated veins.     

The potential role of inducible nitric oxide synthase (iNOS) activity in the testicular dysfunction associated with varicocele: An experimental study

Nitric oxide (NO) has been reported to be increased in the spermatic veins of men affected by varicocele. The aim of the present study was to determine whether iNOS (inducible nitric oxide synthase) has a role in testicular dysfunction associated with varicocele, immunohistochemistry analyze was used to study iNOS activity in testis of adolescent rats with experimental left varicoceles. Rats were randomly divided into three groups. The first group consisted of rats undergoing partial ligation of left renal vein (n:12). The second group consisted of rats undergoing a sham operation (n:6) and, the third group referred to as control rats (n:7). Immunohistochemistry slides were evaluated by counting the number of positive cells and expressed as percents (% iNOS activity). We found that iNOS was predominantly expressed in the cytoplasm of Leydig cells in each group and only a small amount of iNOS was expressed in Sertoli cells. There were significant differences in % iNOS activity between both testes of varicocele group and both of testes control group(p < 0.01), but no significant differences were noted between other groups (p > 0.05). Because of iNOS activity was markedly increased in the Leydig cells of varicocele bearing rats, we suggest that iNOS activity may play a role in the testicular dysfunction associated with varicocele during adolescence. This revised version was published online in August 2006 with corrections to the Cover Date.     

COMPARISON OF BILATERAL VERSUS UNILATERAL VARICOCELECTOMY IN MEN WITH PALPABLE BILATERAL VARICOCELES

PURPOSE: The left varicocele is usually larger in men with bilateral varicoceles. We hypothesized that most of the benefit of varicocelectomy would derive from repair of the larger varicocele. To test this hypothesis we prospectively compared the effect of unilateral versus bilateral microsurgical varicocelectomy in men with large (grade III) or moderate (II) left varicocele associated with small but palpable (I) right varicocele. MATERIALS AND METHODS: A total of 91 patients were prospectively followed and included in the study. Of the patients 65 underwent bilateral and 26 underwent unilateral left repair. All patients underwent preoperative and postoperative semen analysis. RESULTS: Motile sperm concentration increased from 12.1+/-1.7 to 23.7+/-31.8 (95.8% change) in the bilateral group compared with an increase from 19.5+/-21.4 to 27.8+/-34.8 (42.6% change) in the unilateral group (p<0.05). Similarly, sperm concentration increased from 23.8+/-29.5 to 48.6+/-61.3 (157.6% change) in the bilateral group compared with an increase from 41.1+/-40.9 to 59.5+/-66.7 (44.8% change) in the unilateral group (p<0.05). CONCLUSIONS: Bilateral varicocelectomy resulted in significantly greater improvement in post-operative seminal parameters than unilateral repair in patients with grades II to III left varicocele associated with grade I right varicocele. Even a small, unrepaired palpable right varicocele continues to have a detrimental effect on bilateral testis function. Men with bilateral palpable varicoceles require bilateral repair.     

The potential role of inducible nitric oxide synthase (iNOS) activity in the testicular dysfunction associated with varicocele: an experimental study

Nitric oxide (NO) has been reported to be increased in the spermatic veins of men affected by varicocele. The aim of the present study was to determine whether iNOS (inducible nitric oxide synthase) has a role in testicular dysfunction associated with varicocele, immunohistochemistry analyze was used to study iNOS activity in testis of adolescent rats with experimental left varicoceles. Rats were randomly divided into three groups. The first group consisted of rats undergoing partial ligation of left renal vein (n:12). The second group consisted of rats undergoing a sham operation (n:6) and, the third group referred to as control rats (n:7). Immunohistochemistry slides were evaluated by counting the number of positive cells and expressed as percents (% iNOS activity). We found that iNOS was predominantly expressed in the cytoplasm of Leydig cells in each group and only a small amount of iNOS was expressed in Sertoli cells. There were significant differences in % iNOS activity between both testes of varicocele group and both of testes control group (p < 0.01), but no significant differences were noted between other groups (p > 0.05). Because of iNOS activity was markedly increased in the Leydig cells of varicocele bearing rats, we suggest that iNOS activity may play a role in the testicular dysfunction associated with varicocele during adolescence.     

Magnified and non magnified subinguinal varicocelectomy in infertile and/or symptomatic men: A comparative study of the outcome

ObjectiveTo compare the outcome of magnified and non magnified varicocelectomy for infertile and/or symptomatic men.Patients and methodsOne hundred and sixteen patients with 2nd and 3rd degree varicocele were treated in a university based hospital between January 2006 and July 2008. Sixty patients were randomly allocated to be operated upon by conventional subinguinal technique and this is the 1st group (9 patients of them with bilateral varicocele). Other 56 patients were operated upon by microsurgical subinguinal technique and this is the 2nd group (11 of them with bilateral varicocele). All patients were followed up at regular intervals, every 3 months for 3 years, 7 patients were lost during follow-up period, all of them with unilateral varicocele (3 patients from 1st group and 4 patients from 2nd group).ResultsSixty-six varicocelectomies in the 1st group were done by conventional subinguinal technique (57 unilateral and 9 bilateral). Their results had been shown; 8 unilateral hydroceles (12.1%), 7 unilateral recurrences (10.7%) and one scrotal hematoma (1.5%). In the 2nd group total varicocelectomies were 63 (52 unilateral and 11 bilateral) had been done by microsurgical subinguinal technique resulting in no hydroceles and no scrotal hematomas but there were two unilateral recurrence (3%). The differences between the two techniques in the incidence of hydrocele formation and varicocele recurrence are significant (P < 0.001) and (P < 0.03) respectively.ConclusionApproaching the testis via a small subinguinal incision gives direct access to all testicular venous drainage. Furthermore, using the operating loupes helps to ease the recognition of the small venous channel, the testicular artery and the lymphatics, thus resulting in significant decrease of the incidence of varicocele recurrence, persistence, hydrocele formation and testicular artery injury. It is considered safe, effective and less morbid method for varicocelectomy.     

Development of a Varicocele Following Left-Sided Nephrectomy in Kidney Donors

Introduction

Most kidney transplantation surgeons tend to prefer the left-sided kidney for donation. Because one of the veins to join the left renal vein is the left testicular (gonadal) vein, its flow may be damaged by manipulation of the left renal vein during left-sided nephrectomy. We sought to evaluate changes of the left-sided pampiniform venous plexus and testis following left-sided nephrectomy in kidney donors.

Methods

During the present cross-sectional study (June 2007-July 2008), 54 healthy males who were candidates for left kidney donation underwent an ultrasound study of the left-sided pampiniform venous plexus diameter as well as the left testis size before and 4 months after left-sided nephrectomy.

Results

The patient mean age was 25.07 ± 2.49 years. The mean diameters of left pampiniform vein before versus 4 months after nephrectomy were 1.37 ± 0.40 versus 2.04 ± 0.49 mm, respectively. The mean sizes of left testis before and 4 months after nephrecomy were 21.86 ± 2.47 versus 21.50 ± 2.17 mL, respectively. The mean left pampiniform vein diameter significantly increased at 4 months after left-sided nephrectomy (P < .001), but the mean left testis size was not significantly changed (P = .136).

Conclusion

Four months after left-sided nephrectomy, the left pampiniform venous plexus diameter increased, whereas there was no significant change in left testis size. Therefore, in patients with left-sided nephrectomy, a high risk of varicocele may be predicted.     

Ultrasound findings after radiofrequency ablation of the great saphenous vein: descriptive analysis

OBJECTIVE: As an emerging endovascular alternative to ligation and stripping of the incompetent greater saphenous vein (GSV), radiofrequency ablation was monitored with ultrasound scanning to evaluate anatomic results. Neovascularization and inflammation are potential consequences that lead to the appearance of small vessels. The natural history of the below-knee untreated GSV segment may be important in our understanding of ongoing chronic venous disease. An ultrasound follow-up study was conducted to determine the prevalence of small vessel networks, defined as veins and arteries less than 2 mm in diameter, adjacent to the saphenofemoral junction (SFJ); prevalence of small vessel networks adjacent to the treated GSV in the thigh; and fate of the below-knee untreated GSV distal to the ablated segment. METHODS: One hundred six extremities with radiofrequency ablation of the GSV for treatment of superficial venous insufficiency were followed up with high-resolution ultrasound imaging 4 to 25 months (median, 9 months) after the procedure. Ninety-three limbs had concomitant ligation and division of the SFJ and its tributaries, and 13 limbs underwent radiofrequency ablation without SFJ ligation. Ultrasound was used to evaluate patients for small vessel networks, and concomitant findings of small vessel networks and recanalization at the SFJ and adjacent to the treated GSV. The status of the below-knee segment of untreated GSV was evaluated for patency and reflux. Data analysis compared the findings in the ligation group with those in the no-ligation group, with the chi 2 test and Fisher exact test. RESULTS: We found small vessel networks in 65% (n = 69) of extremities: 15% (n = 16) at the SFJ only, 26% (n = 28) in the thigh only, and 24% (n = 25) at both the SFJ and thigh, resulting in a small vessel network prevalence of 39% (n = 41) at the SJF and 50% (n = 53) in the thigh. The prevalence of small vessel networks at the SFJ was significantly less after radiofrequency ablation with SFJ ligation (34%, 32 of 93) than after radiofrequency ablation without ligation (69%, 9 of 13; P = .035). Small vessel networks and GSV recanalization at the SFJ was more common in patients undergoing radiofrequency ablation without ligation (46%, 6 of 13) than after radiofrequency ablation with ligation (14%, 13 of 93; P = .014). The prevalence of small vessel networks in the thigh was not affected by SFJ ligation. The below-knee GSV was patent in 79% (84 of 106), and 58% (61 of 106) demonstrated reflux, a decrease from the pre-radiofrequency ablation rate of 71% (75 of 106), possibly because thrombosis extended distally beyond the ablated segment in 16% (17 of 106) of the legs. CONCLUSIONS: Small vessel networks were detected adjacent to or in connection with most of the radiofrequency ablation-treated GSVs. SFJ ligation was associated with fewer small vessel networks and proximal GSV recanalization. Most below-knee untreated GSV segments remained patent, and most exhibited reflux.     

Involved intrinsic apoptotic pathway of testicular tissues in varicocele-induced rats

Introduction  Increased testicular germ cell apoptosis has been reported in varicocele-induced rats. We studied intrinsic or extrinsic pathway of apoptosis by detecting Bcl-2, caspase-9, caspase-8, and activated caspase-3 expressions in the bilateral testes of experimental varicocele-induced rats. Materials and methods  Experimental left varicocele (ELV) was created by partial ligation of left renal vein in a study group of 24 adult male Sprague–Dawley rats. The other 24 rats were as control group. Eight rats from each group were killed at 4, 8, and 12 weeks following varicocele creation. Testicular tissues of both groups were sampled for TUNEL assay and immunoblotting. Results  Increased apoptotic germ cell was found in the ipsilateral testis of varicocele group at 8 and 12 weeks after operation (P < 0.05). Increased activated caspase-3 expression in the contralateral (right) testis was noted at 12 weeks following varicocele creation (P < 0.05). Conclusions  Our study demonstrates down-regulation of Bcl-2 expression and increased expressions of caspase-9 and activated caspase-3 in the ipsilateral testis of ELV rats at 8 and 12 weeks, indicating gradually increased testicular tissues apoptosis through the intrinsic pathway in varicocele-induced rats. Simultaneously, increased apoptosis in the contralateral testis was observed at 12 weeks (P < 0.05) following varicocele creation also.     

Great Saphenous Vein Stripping with Liberal Use of Subfascial Endoscopic Perforator Vein Surgery (SEPS)

This study is based on a unique registry of 632 patients who underwent great saphenous vein (GSV) stripping and liberal use of subfascial endoscopic perforator vein surgery (SEPS) for minimal to severe lower limb venous insufficiency. Clinical examinations and color-coded duplex scanning were performed on a randomly selected, manageable sample of 170 limbs to assess the affect of early SEPS on junctional (saphenofemoral [SFJ] and/or saphenopopliteal [SPJ]) and perforator vein (PV) insufficiencies and superficial varicosities at a median of 6.5 years. PV incompetence was present in 68 legs (40%), as the sole transfascial insufficiency in 28 limbs and combined with SFJ or SPJ incompetence in 40 limbs. Junction incompetence alone characterized an additional 38 limbs, bringing the total transfascial insufficiency prevalence to 62%. Superficial varicosities affected 46% of limbs. Overall CEAP clinical class was unimproved beyond preoperative values. PV incompetence was associated with higher CEAP and clinical venous severity scores than were junctional insufficiencies alone. We concluded that PV incompetence alone or combined with junctional insufficiency is associated with increased symptoms and disease progression. The prevalence of SFJ, SPJ, and PV incompetence (62%) and recurrent varicosities (46%) suggests that early use of SEPS does not prevent disease progression and offers no benefit over GSV stripping in the absence of deep vein insufficiency or threatened ulceration.     

Pituitary Gonadal Function in Infertile Men with Varicocele

Infertile men with varicocele or idiopathic infertility were compared with a control group. Spermocytograms were taken and the following radioimmunological plasma analyses carried out: testosterone, FSH and LH before and after 50 micrograms LRH, Prolactin (PRL) before and after 200 micrograms TRH; in addition, 8 patients with varicoceles and 3 controls received LRH intravenously (0.4 microgram/min.) for 4 hours. The binding of [125I] human chorionic gonadotrophin (hCG) to testicular tissue obtained by biopsy from 10 infertile men was also investigated. Of the parameters studied, no differences were found between the unilateral or bilateral varicoceles. In the two groups of infertile men, sperm motility and percentage normal forms were similar and significantly lower than in controls. As compared to the controls, in the groups of infertile men, basal LH and testosterone levels were no different but basal FSH levels was increased, basal PRL was higher (p less than 0.05) in the varicocele group. Responses of the LH, FSH and PRL to LRH and TRH stimulations were generally higher in infertile men than in controls. As compared to the idiopathic infertile men, testosterone levels and responses of plasma FSH to LRH injection were lower in varicocele group. Moreover, in infertile men with varicocele, age was correlated negatively with sperm motility and testosterone level and it was correlated positively with LH response to LRH injection. For each patient, testicular tissue was able to specifically bind [125I]hCG, but in some cases of varicoceles, hCG binding capacity was different in the two testes and seemed higher than that observed in men with obstructive azoospermia. These results suggest: 1) dysfunction in both spermatogenesis and Leydig cells with a compensatory hyperfunction of the pituitary gland in infertile men with varicocele; 2) worsening in Leydig cells and tubular lesions with longer duration of varicocele; and 3) absence of any gross abnormality in hCG binding to its specific receptors in the testis of men with varicocele. These data suggest varicoceles may play a causal role in infertility.     

Color doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination

Objectives

Color Doppler ultrasound (CDU) diagnostic criteria for varicoceles are poorly defined, and the role of CDU in diagnosing varicoceles is controversial. The purpose of this study is to assess the diagnostic accuracy of CDU for varicoceles compared to physical examination.

Methods

We prospectively studied 64 patients with CDU and collected the following data: maximum diameter of scrotal veins, the presence of a venous plexus, sum of the diameter of up to six veins of the plexus, and the duration and amplitude of flow change on Valsalva maneuver. To avoid interphysician variation, all patients were examined by one designated senior urologist with the sonographer remaining unaware of the findings.

Results

CDU parameters of 127 testis units in 64 patients were analyzed and compared to the physical findings. Fifty-nine testis units were positive and 57 units were negative for varicocele on physical examination. In 11 testis units, results of physical examination were inconclusive regarding the presence of varicocele. The commonly accepted CDU criterion for varicocele (maximal vein diameter of 3 mm or greater) had a sensitivity of 53% and specificity of 91% compared to physical examination. We developed a new scoring system incorporating the maximal venous diameter (score 0 to 3), the presence of a venous plexus and the sum of the diameters of veins in the plexus (score 0 to 3), and the change of flow on Valsalva maneuver (score 0 to 3). Using a total score of 4 or more to define the presence of CDU-positive varicocele, we observed a sensitivity of 93% and a specificity of 85% when compared to physical examination. All moderate to large varicoceles found on physical examination were positive by CDU diagnosis using the scoring system, but the same group had only a 68% positive rate by traditional CDU diagnostic criteria.

Conclusions

Using the proposed new scoring system, CDU has been shown to be a reliable and accurate method of diagnosis for varicoceles compared to the current reference standard physical examination. CDU has the advantages of being able to objectively examine venous plexus and measure blood flow parameters and to be less observer-dependent than physical examination. UROLOGY 50: 953-956, 1997.     

The Valvular Apparatus in Venous Insufficiency: A Problem of Quantity?

n = 51) with symptomatic venous insufficiency undergoing saphenectomy (VI) were compared with the number of GSV valves in patients (n= 26) without venous insufficiency undergoing in situ GSV bypass under angioscopic surveillance who served as a control group. The two groups differed, as expected, in age and sex distribution. The VI group had a mean of 25.7 ± 11.0 centimeters of GSV between valves, while the control group had 19.0 ± 9.7 centimeters of GSV between valves (F = 6.99; p= 0.01). The mean number of valves in the saphenous veins of the two groups also differed significantly: VI = 2.3 ± 0.83 versus control (CTRL) = 4.8 ± 2.01 (F = 61.86; p < 0.0001). That properly functioning valve leaflets help maintain physiologic antegrade venous flow is indisputable. This study, however, suggests that the relative lack of valves may be related to the development of venous insufficiency. This report documents that patients with symptomatic reflux in the GSV have significantly fewer valves than patients with apparently normal functioning saphenous veins.     

男性不育患者精索静脉曲张的超声诊断研究

目的:探讨高频超声诊断男性不育患者精索静脉曲张(varicocele,VC)的检测指标及其VC导致睾丸体积改变情况。方法:采用高频超声方法对46例正常对照者的精索静脉及178例男性不育患者左侧曲张的精索静脉进行了检测。根据临床及超声检查结果将178例VC患者分为4组,其中亚临床型VC(SVC)组45例,临床型VCⅠ级(VCⅠ)组44例,Ⅱ级(VCⅡ)组48例,Ⅲ级(VCⅢ)组41例。结果:①对照组双侧平静呼吸时精索静脉最大内径(DR)、Valsalva试验时精索静脉最大内径(DV)、最大返流速度(Vmax)、返流持续时间(TR)及睾丸体积差别均无显著性(P>0.05);②VC组与对照组及各级VC组DR、DV、Vmax、TR比较的差别具有显著性(P<0.001);③各VC组左侧睾丸体积小于右侧(P<0.01),VCⅡ、VCⅢ组右侧睾丸体积小于对照组(P<0.05),VCⅢ组左侧睾丸体积小于SVC组(P<0.05)。结论:①高频超声可为男性不育VC患者提供精确的精索静脉内径、血流动力学及睾丸大小等客观指标,有助于男性不育病因的筛选;②单侧VC可引起双侧睾丸体积变小,尤以左侧为甚,亚临床型及临床型VC均可导致患侧睾丸体积缩小,且VC愈严重,睾丸体积愈小。     

High ligation of the saphenofemoral junction in endovenous obliteration of varicose veins

BACKGROUND: Endovenous radiofrequency (RF) ablation of the greater saphenous vein has become an accepted treatment modality. This study examines if it is necessary to perform high ligation of the saphenous vein to insure success of the procedure. STUDY DESIGN: A retrospective chart analysis was conducted on 219 patients who underwent RF ablation for venous insufficiency. All procedures were performed by 3 board-certified vascular surgeons. One surgeon always ligated the saphenofemoral junction (SFJ), the second never ligated, and the third ligated selectively. Demographic data were collected and analyzed. RESULTS: A total of 77 patients underwent RF ablation with ligation of the SFJ (group I), and 142 patients underwent ablation without ligation (group II). Both groups had similar ablation success rates (P = .0960), 92% (group I) and 84% (group II). CONCLUSION: Saphenofemoral junction ligation is not indicated on a routine basis to achieve success with endovascular ablation of the greater saphenous vein.     

Correlation of testicular color Doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility

High resolution color Doppler ultrasound is a noninvasive means of simultaneously imaging and evaluating the blood flow to the testes. To define the ability of color Doppler ultrasound to detect clinically evident as well as subclinical varicoceles men referred to our urology division with oligospermia and infertility underwent spermatic vein venography of the left testis if there was physical examination and/or color Doppler ultrasound evidence of a varicocele. The detection of valvular incompetence on venography was considered diagnostic for a varicocele. Of 17 study patients physical examination detected 10 of 14 venographically evident varicoceles (71%), whereas color Doppler ultrasound detected 13 of 14 (93%). Of 5 patients with a normal physical examination but with color Doppler ultrasound evidence of a varicocele 4 had a confirmatory venogram, and 1 of 2 patients with a varicocele on physical examination and a normal Doppler ultrasound had a positive venogram. These data suggest that color Doppler ultrasound of the testis may more appropriately direct further invasive testing and therapy of infertile men than physical examination alone.