Laparoscopic Varicocele Ligation Research Articles

Low-frequency neuromuscular electrical stimulation as a treatment for anejaculation caused by iatrogenic injury of the abdominal aorta: a case study

Anejaculation is the inability to ejaculate during sexual activity, either in an antegrade or retrograde fashion. Both anejaculation following an iatrogenic injury of the abdominal aorta and the efficacy of low-frequency neuromuscular electrical stimulation (NMES) in treating anejaculation have been reported rarely. In this case report, we describe a patient who experienced anejaculation following an iatrogenic injury to the abdominal aorta and eventually regained normal ejaculation ability following treatment with NMES. The patient, a 23-year-old Chinese man, underwent laparoscopic varicocele ligation on both sides, during which he sustained a ruptured wound in the abdominal aorta from a 10-mm trocar. To stop the bleeding, he underwent abdominal aortic balloon catheter dilatation combined with covered stent implantation. However, 10 days after the endovascular interventions, the patient developed hemorrhagic shock and underwent emergency exploratory laparotomy and adventitial suture of the abdominal aorta. Despite normal erectile function since a week after the last surgery, the patient complained of aejaculation for a year during intercourse or masturbation. After receiving NMES treatment for over two months, the patient reported successful intravaginal ejaculation during intercourse, and the improvement persisted for a month after treatment. Altogether, these findings suggest that NMES could be a feasible, safe, and cost-effective treatment method for improving anejaculation and provides a novel option for patients with this condition.

Laparoscopic varicocelectomy in male infertility : Improvement of seminal parameters and effects on spermatogenesis.

BackgroundThe suitability of laparoscopic varicocelectomy for assisted reproductive technology depends on the improvement of semen parameters. The present study analyzed the improvement of semen parameters following laparoscopic varicocele ligation.Material and methodsA retrospective study of the laparoscopic varicocele clippings at the Department of Urology of University Hospital of Kiel between the years 2007 and 2019 was conducted. The semen analyses according to WHO standards (sperm count, density, motility and morphology) were conducted before and 12 months after surgery. Screening for surgical complications took place at the time of the follow-up seminal analysis. Included were patients with oligozoospermia, asthenozoospermia and/or teratozoospermia (group 1, OAT) or with nonobstructive azoospermia (group 2, NOA).ResultsThis study included data of 27 patients and 22 patients presented preoperative OAT (81%, group 1). Another 5 patients showed NOA (19%, group 2). Data of group 1 showed that semen parameters normalized in 32% of the patients after surgery. Significant improvement in total sperm count (p < 0.005), sperm density (p < 0.005) and total motile sperm count (p < 0.005) was observed. No deterioration of semen parameters was observed. In group 2 we detected spermatozoa in 1 case in the postoperative ejaculate. None of the patients showed complications according to the Clavien-Dindo classification, postoperative hydrocele formation or recurrence of varicocele at the time of control spermiogram.ConclusionLaparoscopic varicocelectomy is a valid therapeutic approach to improve semen parameters for further assisted reproductive techniques. Spermatogenesis may be induced for patients with NOA. Normalization of semen parameters can be achieved for patients with OAT.

Laparoscopic varicocelectomy initial experience at Al_Azhar Hospital (Demietta)

Background: Varicocele is a collection of dilated veins in the pampiniform plexus that drain the testicle and may contribute to male infertility. A variety of surgical & non-surgical approaches have been advocated for varicocele treatment. Objective: Evaluate laparoscopic varicocelectomy with regard to intra and post-operative parameters. Patients and Methods: At Departments of urology of Al_azhar University Hospitals (Damietta). Prospective randomized study was performed about laparoscopic varicocelectomy during the period from June 2016 to December 2017 after obtaining informed consent. The group included patients with clinically palpable varicocele confirmed by U/S complaining of infertility (primary, secondary) or chronic testicular pain. Results: The range operative bilateral Laparoscopic Varicocelectomy time was 60-90 minutes. There were no intra operative complications in the study group. The average hospital stay was 24-36 hours. Post-operative analgesics (2-3) doses, daily activities initiation usually started after 4-5days. Hydrocele formation was seen in (11.1%) patients recurrence was seen in (5.6%) patient. None of the patient has developed an atrophic testis as a result of the laparoscopic procedure. Patients had improvement of the seminal fluid parameters during follow up period and pregnancy rate was (25%). CONCLUSION: Laparoscopic varicocele ligation is a simple and safe technique causing minimal morbidity and enabling rapid return to normal activity.

Laparoscopic varicocelectomy initial experience at Al_Azhar Hospital (Demietta)

Background: Varicocele is a collection of dilated veins in the pampiniform plexus that drain the testicle and may contribute to male infertility. A variety of surgical & non-surgical approaches have been advocated for varicocele treatment. Objective: Evaluate laparoscopic varicocelectomy with regard to intra and post-operative parameters. Patients and Methods: At Departments of urology of Al_azhar University Hospitals (Damietta). Prospective randomized study was performed about laparoscopic varicocelectomy during the period from June 2016 to December 2017 after obtaining informed consent. The group included patients with clinically palpable varicocele confirmed by U/S complaining of infertility (primary, secondary) or chronic testicular pain. Results: The range operative bilateral Laparoscopic Varicocelectomy time was 60-90 minutes. There were no intra operative complications in the study group. The average hospital stay was 24-36 hours. Post-operative analgesics (2-3) doses, daily activities initiation usually started after 4-5days. Hydrocele formation was seen in (11.1%) patients recurrence was seen in (5.6%) patient. None of the patient has developed an atrophic testis as a result of the laparoscopic procedure. Patients had improvement of the seminal fluid parameters during follow up period and pregnancy rate was (25%). CONCLUSION: Laparoscopic varicocele ligation is a simple and safe technique causing minimal morbidity and enabling rapid return to normal activity.

Comparison the outcomes of laparoscopic varicocele ligation and microscopic varicocelectomy in preadolescent and adolescent boys

Comparison the outcomes of laparoscopic varicocele ligation and microscopic varicocelectomy in preadolescent and adolescent boys

Ergonomic varicocele ligation

Introduction/aim Many surgical and radiological techniques have been introduced for treating varicoceles. The goal of surgical treatment of varicocele is to occlude the refluxing venous drainage to the testis while maintaining the normal testicular function. The aim of this study was to present our initial experience in laparoscopic varicocele treatment using intracorporeal knot-tying with available laparoscopic instruments. Materials and methods A retrospective file review of the patients who were treated with laparoscopic intracorporeal knot-tying between May 2010 and July 2014 was carried out. The patients were evaluated as regards age, symptoms, and clinical grade of varicocele. All patients were diagnosed through physical examination and color Doppler ultrasound, which measured the diameter of spermatic veins and retrograde flow in spermatic veins after the Valsalva maneuver. Results The mean operative time was 35± 8 min. There was no intraoperative complication, and all patients had uneventful postoperative courses. Patients were discharged from hospital on the same day after surgery. No recurrent varicocele, testicular atrophy, postoperative hydrocele, or ematoma were observed. Conclusion Our preliminary results indicate that laparoscopic varicocele ligation carried out with intracorporeal knot-tying is safe and effective and produces cosmetically better results. Therefore, it is a suitable procedure in both pediatric and adolescent patients. Keywords : ergonomics, intracorporeal knot-tying, laparoscopic varicocelectomy

Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL) for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II–III according to the Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45). The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.

AB121. Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation for varicocele: a meta-analysis

ObjectiveTo compare perioperative and postoperative outcomes of laparoendoscopic single-site (LESS) surgery and conventional transperitoneal laparoscopic varicocele ligation (CTL-VL) for varicocele.Material and methodsPubMed, Medline, EMBASE, ISI Web of Knowledge, Cochrane Library, Chinese biomedicine and China Knowledge Resource Integrated (CNKI) databases were searched for studies released prior to February 2014. References of included studies were also searched to identify additional, potentially relevant studies. We analyzed the data using RevMan 5.1.ResultsTen randomized controlled trials (RCTs) and seven non-randomized controlled trials (NRCTs) were included, involving 1,183 patients. LESS group showed longer operative time but shorter hospital stay, shorter time to return to normal activity and lower total postoperative complications incidence. No significant difference was found in terms of blood loss, VAS pain score, pregnancy and improvement of semen parameters. Patients’ satisfaction was significantly better in LESS group. Sensitivity analysis showed similar results to the original analysis, and no evidence of publication bias was showed.ConclusionsLESS showed comparable outcomes to that of CTL-VL, but it takes shorter to recover, has fewer postoperative complications and shows advantages in patients’ satisfaction potentially for cosmesis and less pain. More high-quality, multicenter and long-term RCTs are required to verify the findings.

Ergonomic laparoscopic varicocele ligation: A case and technical report

The goal of surgical treatment of the varicocele is to occlude the refluxing venousdrainage to the testis while maintaining normal testicular function. Many surgicaltechniques for treating varicoceles have been described. We aim to present an adolescentcase with varicocele treated by simple laparoscopic ligation technique usingintracorporeal knot-tying.

Laparoendoscopic Single-Site Surgery with a Single Channel Versus Conventional Laparoscopic Varicocele Ligation: A Prospective Randomized Study

The objective of this study was to evaluate the safety and feasibility of single channel laparoscopy in the treatment of patients with varicocele. Ninety patients with clinically palpable varicoceles were randomly assigned to receive laparoendoscopic single-site with a single channel varicocele ligation (LESS[sc]-VL) (n=45) or conventional transperitoneal laparoscopic varicocele ligation (CTL-VL) (n=45). Patient characteristics, perioperative details, total procedural cost, time to return to work, visual analogue scale (VAS) pain score, semen parameters, and cosmetic results were recorded. There were no differences in operative time (P=0.102), postoperative hospitalization time (P=0.130), total cost (P=0.112), or postoperative complications (P>0.05) between the two groups. Time to return to normal activities was shorter in the LESS(sc)-VL group than that in the CTL-VL group (P=0.018). The mean of all semen parameters were improved statistically 3 months after ligation (P<0.001). The VAS incision pain score was significantly lower 6 and 24 hours after surgery in patients who underwent LESS(sc)-VL(P<0.05). Patients who underwent LESS(sc)-VL had a better cosmetic result, reflected by both the verbal response scale and the numeric scale (P=0.008 and P=0.005, respectively). LESS(sc)-VL is a safe and effective minimally invasive surgical alternative for varicocelectomy. Compared with CTL-VL, LESS(sc)-VL may decrease postoperative pain and hide the surgical incision better within the umbilicus.

839 Laparoendoscopic single-site surgery with a single channel versus conventional laparoscopic varicocele ligation: A prospective randomized study

839 Laparoendoscopic single-site surgery with a single channel versus conventional laparoscopic varicocele ligation: A prospective randomized study

Five mm laparoscopic varicocelectomy versus conventional varicocele ligation in young men with symptomatic varicocele: A randomized clinical study

To compare the therapeutic success, morbidity and the costs of 5 mm laparoscopic varicocele ligation (LV) compared to inguinal varicocelectomy (IV). Eighty patients with idiopathic symptomatic varicocele of grades I–III diagnosed by clinical examination and Doppler ultrasonography were randomly assigned to LV or IV (40 patients in each group). The mean patient age was 25.2 ± 1.4 (range 18–40) years. Of the 80 patients treated 21.3% had a left-sided varicocele, 70% had bilateral varicoceles and 8.8% a right-sided varicocele. Of 136 varicoceles, 37 (27.2%) were grade III, 51 (37.5%) grade II and 48 (35.3%) were grade I. The indications for varicocele ligation were: abnormal spermiogram in 47 patients (58.7%), scrotal pain in 19 (23.8%) and cosmetic impairment in 14 (17.5%). A total of 136 varicocele ligations were performed (67 IV and 69 LV). All patients were followed up for 4–8 months to assess early complications, testicular size, late complications and persistence or recurrence of the varicocele. LV was associated with shorter operative time, shorter hospital stay and lower cost compared to IV. The overall incidence of postoperative complications including hydrocele, epididymitis and local pain was significantly higher among patients undergoing IV compared with LV (17.5% vs 5%). The incidence of persistent varicoceles was not significantly different between the 2 groups, but the varicocele recurrence rate was significantly lower in the LV compared to the IV group (5% vs. 17.5%, p ≤ 0.02). LV is a less invasive treatment than IV for managing male varicoceles. It is also associated with lower costs and better outcomes and should therefore be the preferred method of treatment for male varicoceles.

Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation in men with palpable varicocele: A randomized, clinical study

This study was designed to compare the outcomes of two different surgical techniques: conventional transperitoneal laparoscopic varicocele ligation (CTL-VL), and laparoendoscopic single-site varicocele ligation (LESS-VL), using transumbilical home-made single port device. Our sample included 82 male patients with 92 clinically palpable varicoceles who underwent varicocelectomy. The patients were randomly allocated to one of two groups according to varicocele ligation technique. Early postoperative complications, hospital stay, time to return to work, degree of satisfaction, and semen parameters were assessed. A visual analogue scale (VAS) pain score that ranged from 0 to 10 and analgesia requirements during the postoperative course were used to evaluate postoperative pain. The operating room time and hospital stay of the two study groups were comparable, but time to return to normal activity was significantly shorter in the LESS group compared with the CTL group (P = 0.025). Both VAS and the postoperative use of analgesics were significantly lower during postoperative days 2 (P = 0.005) and 3 (P = 0.047) in patients who underwent LESS-VL compared with patients who underwent CTL-VL. Significant improvements in sperm count, motility, and morphology were observed in both groups (P < 0.001; at each of the variables in both groups), but the proportion of patients who showed improvement was not significantly different between the two groups. This relatively small-scale study suggests that LESS-VL is a safe and effective alternative to CTL-VL that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus.

Laparoscopic versus Various Types of Open Ligation of Testicular Veins for Treatment of Varicocele

Varicocele therapy is controversial issue with no single approach adopted as the best therapeutic option. Patient were divided into groups which received 2 different modalities of treatment [namely high ligation of testicular veins, Paloma operation and subinguinal microscopic varicocelectomy [SMV] and compare them with laparoscopic varicocele ligation [LVL]. Group 1[164 patients] treated with LVL. Group 2 [101 patients] treated with open method [65 patients with paloma and 36 patients with SMV]. Group 1 showed less recurrent rate [4%] vs. [8%] for group 2. Less hospital stay for group 1 [1.3 days] vs.[3.5 days] for group 2. Return to normal activity was shorter in group 1 [4.5 days] vs. [9 days] in group 2. More costeffective for group 1 patients than group 2.Aims and objectives: The aim of this study was to compare theeffectiveness and safety of laparoscopic and conventional methods(open technique) in the treatment of varicocele. The followingparameters were evaluated for both laparoscopic and open procedures.1. Operative technique2. Patient selection3. Operating time4. Postoperative complications including recurrences5. Hospital stay6. Cost-effectiveness.Material and methods: A literature search was performed using medlineand other search engines, the following search terms were used[laparoscopic versus open methods in treatment of varicocele]. Criteriafor selection of the literature were no. of cases, methods of analysisoperative time and institution where the study was done.

Genitofemoral Nerve Injury After Laparoscopic Varicocelectomy in Adolescents

Genitofemoral nerve injury is an underappreciated complication after laparoscopic varicocele ligation in teenage boys. We describe the incidence according to ligation instrument and the pattern of spontaneous symptom resolution. Patients who underwent laparoscopic varicocele ligation between 2004 and 2007 were retrospectively grouped by ligation modality (clipping or cautery by ultrasonic shears). The incidence of iatrogenic genitofemoral nerve injury was assessed and compared. To illustrate the pattern of resolution, 1 affected patient documented the decreasing area of paresthesia through time on a topographic map. During the study period laparoscopic varicocele ligation was performed using ultrasonic shears in 12 boys and endoscopic clips/cold dissection in 15. Genitofemoral nerve injury occurred in 2 patients using ultrasonic shears (17%) and no patient in the clip/cold dissection group (p = 0.10). In both patients the paresthesias resolved completely by 8 months. Genitofemoral nerve injury may be more frequent when the dissection is performed using "hot" methods such as cautery by ultrasonic shears. Preoperatively, patients should be made aware of the relatively high incidence and the usually self-limiting nature of this complication.

Lymphatic staining to prevent hydrocele after laparoscopic varicocele ligation

Lymphatic staining to prevent hydrocele after laparoscopic varicocele ligation

Laparoscopic varicocele ligation in children and adolescents using isosulphan blue: a prospective randomized trial

To evaluate, in a randomized prospective trial in children and adolescents, the feasibility of isosulphan blue-based lymphatic vessel preservation during laparoscopic varicocelectomy and its impact on the complication rate, as the operative management of varicoceles remains controversial. In all, 50 consecutive patients were randomly assigned to two laparoscopic varicocelectomy groups. The indications for surgery included scrotal pain and a difference in testicular size, as well as severe cosmetic impairment. All the patients had a laparoscopic varicocelectomy using three ports. Patients in group A had standard laparoscopy, while those in group B had additional isosulphan blue administered. After surgery, the patients were assessed at 3, 6 and 12 months for varicocele recurrence, hydrocele formation, atrophy, pain or other complications. There were no intraoperative complications or conversions to open surgery. There were no adverse reactions, scrotal haematomas or atrophy. At 3 months after surgery, the incidence of hydrocele in group A was 20% whereas in group B no hydroceles were detected (P = 0.025); at 6 months the 20% still had hydroceles. One patient in each group had varicocele recurrence associated with persistent pain. In two patients in group B, blue pigmentation of the left hemiscrotum persisted at the 3-month follow-up but resolved by 6 months. Laparoscopic repair of varicoceles using isosulphan blue helps to identify and preserve the lymphatic drainage. It prevents secondary hydrocele formation, the most common complication, with no supplementary risk to the patient. Also, testicular oedema causing impaired spermatogenesis can be avoided.

Laparoscopic varicocele ligation: Are there advantages compared with the microscopic subinguinal approach?

Objectives To compare the operative time, outcome, complications, and patient costs between laparoscopic varicocele ligation (LVL) and subinguinal microscopic varicocelectomy (SMV) in two patient cohorts. Varicocele therapy is a controversial issue, with no single approach adopted as the best therapeutic option. LVL has been considered more expensive and of no proven benefit compared with SMV. Methods We compared two groups of patients who underwent surgical correction of varicocele at our institutions during a 6-year period. Group 1 included postpubertal adolescents who underwent LVL and group 2 included adults seen at an infertility practice who underwent SMV. The outcome measures selected included operative time, direct hospital costs to the patient, and negative outcomes. Results We identified a total of 72 patients, 36 (mean age 13.8 years) in group 1 and 36 (mean age 34.1 years) in group 2. Group 1 had no persistent or recurrent varicoceles compared with 4 patients in group 2. Three men in group 2 required emergency room evaluation and no patient did so in group 1. No hydroceles developed in group 2, but three developed in group 1. Conclusions LVL resulted in shorter operative times and fewer negative outcomes compared with SMV. This translated into lower direct patient costs for LVL. For those who have mastered laparoscopic techniques, LVL should be considered a safe, cost-effective option in the correction of varicoceles.

Are sperm motion parameters influenced by varicocele ligation?

Objective: To document objectively, improvements in sperm motion parameters in subfertile men after varicocele ligation with the use of computer-aided sperm analysis. Design: Retrospective chart review. Setting: An academic clinical environment. Patient(s): Thirty-four men with varicocele as the primary cause of infertility who underwent a physical examination, hormonal profile, and Doppler ultrasound evaluation. Intervention(s): Computer-aided sperm analysis was performed before and after either subinguinal or laparoscopic varicocele ligation. Main Outcome Measure(s): Patients were followed up for 3–18 months after operation, and average computer-aided sperm analysis values were obtained before and after operation. Computer-aided sperm analysis values were analyzed by paired Student’s t-test, with special reference to motility and sperm motion parameters. Result(s): After varicocele ligation, patients demonstrated increases in mean sperm density and in the overall distribution of sperm with rapid velocity, although the increases were not statistically significant. Mean measures of straightness, linearity, and track speed also were increased after operation, but only progressive sperm velocity was increased to a statistically significant level. Conclusion(s): Because progressive velocity has been a primary computer-aided sperm analysis parameter predictive of male fertility and the success of assisted reproductive techniques, we conclude that varicocele ligation results in improvements in semen parameters, especially the key parameter of progressive sperm velocity.

Laparoscopic varicocele ligation: a recommendable standard procedure with good long-term results.

In the last 2 years we have performed 100 laparoscopic varicocele ligations. The indications for surgery were pain, a small testicle or prevention of subfertility. 4 patients had undergone previous embolization therapy or open operation and developed recurrences. 5 patients had bilateral varicocele. No severe intraoperative complications occurred. Postoperative complications were of low morbidity and were managed conservatively. The follow-up time was 3-30 months. The overall persistence and recurrence rate was 8%. Laparoscopic varicocele ligation is safe and can be recommended.