Abstract
Anatomical differences between adults and adolescents and between left and right varicoceles were shown in this work. We designed a standardized and reproducible method for pressure measurement in the inguinal internal spermatic vein (ISV). We demonstrated that the mean absolute pressure in the ISV in the upright position is higher than the veno-capillary pressure in the testicle, and hence could impair spermatogenesis prompting the need for treatment in varicoceles. Histoacryl transparent and Glubran2, the current commercially available adhesives for the treatment of varicoceles, do not differ with regard to efficiency, safety and tolerance during and after embolization. Both adhesives cause a mild pain in 30% of the patients in the week after embolization. The radiation exposure is low during embolizations of varicoceles with highly viscous liquid products. Therefore, the endovascular treatment with glue is an efficient, safe and tolerable method of treatment for varicoceles when applicable.
Highlights
This thesis aimed at contributing to the pathophysiology and treatment of varicoceles
The specific objectives of these clinical studies were to assess: (i) the safety, efficacy and tolerance of two types of glue and a non-gluing liquid embolic agent, in the endovascular treatment of varicoceles, (ii) to assess radiation burden for patient during varicocele embolization, (iii) to develop a standardized method to read the phlebographic anatomy of varicoceles and to test a different ontogenesis of varicoceles in adolescents and adults, and (iv) lastly to develop a standardized method to measure the intravascular pressure in the internal spermatic vein and to determine whether infertility in varicoceles can be explained by the principle of elevated hydrostatic pressure
There are currently two commercially available tissueadhesives that can be used for the embolization of varicoceles
Summary
This thesis aimed at contributing to the pathophysiology and treatment of varicoceles. The specific objectives of these clinical studies were to assess: (i) the safety, efficacy and tolerance of two types of glue and a non-gluing liquid embolic agent, in the endovascular treatment of varicoceles, (ii) to assess radiation burden for patient during varicocele embolization, (iii) to develop a standardized method to read the phlebographic anatomy of varicoceles and to test a different ontogenesis of varicoceles in adolescents and adults, and (iv) lastly to develop a standardized method to measure the intravascular pressure in the internal spermatic vein and to determine whether infertility in varicoceles can be explained by the principle of elevated hydrostatic pressure. Presentation, incidence and epidemiology of varicoceles The vast majority of adolescents with varicoceles are asymptomatic [1]. It may be an incidental finding, being discovered at a routine school medical examination.
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