Left-sided Varicocele Research Articles

Percutaneous retrograde endovascular occlusion for pediatric varicocele

Background/PurposeThe aim of this study was to assess whether percutaneous retrograde endovascular occlusion (PREVO) is effective and safe for the treatment of varicocele in pediatric patients. MethodsWe retrospectively studied 71 children who underwent PREVO for left-sided varicocele. The primary outcome was the proportion of varicocele-free patients 6 months after PREVO as assessed by ultrasonography. ResultsSeventy-one boys with left-sided grade III varicocele underwent PREVO at a mean age of 13.2 years. PREVO was performed under local anesthesia in all boys but 2, who required general anesthesia. The procedure was technically feasible in 68 (96%) patients. In the remaining 3 patients, the internal spermatic vein could not be catheterized. Minor short-term complications occurred in 6 patients and resolved fully. No major complications or deaths were recorded. The proportion of varicocele-free patients 6 months after PREVO was 93% (66/71) overall and 97% (66/68) in the patients whose PREVO procedure was feasible. No clinical recurrence was observed during the mean follow-up of 17.5 months. ConclusionsPercutaneous retrograde endovascular occlusion is an effective minimally invasive approach for varicocele treatment in pediatric patients. It can be safely performed on an outpatient basis under local anesthesia.

Left renal vein thrombosis causing left‐sided varicocele

Internal Medicine JournalVolume 41, Issue 2 p. 211-212 Left renal vein thrombosis causing left-sided varicocele S. A. Puthiyaveetil, S. A. Puthiyaveetil Department of Medicine, Armidale Rural Referral Hospital, Armidale, New South Wales, AustraliaSearch for more papers by this authorA. Mathew, A. Mathew Department of Medicine, Armidale Rural Referral Hospital, Armidale, New South Wales, AustraliaSearch for more papers by this author S. A. Puthiyaveetil, S. A. Puthiyaveetil Department of Medicine, Armidale Rural Referral Hospital, Armidale, New South Wales, AustraliaSearch for more papers by this authorA. Mathew, A. Mathew Department of Medicine, Armidale Rural Referral Hospital, Armidale, New South Wales, AustraliaSearch for more papers by this author First published: 25 February 2011 https://doi.org/10.1111/j.1445-5994.2010.02416.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume41, Issue2February 2011Pages 211-212 RelatedInformation

Retroaortic Left Renal Vein in a Case of Left Adrenal Adenoma: Radiological Findings

It is important to diagnose retroaortic left renal vein (RLRV) before a probable retroperitoneal surgery in a case of a suspicious adrenal mass. Our purpose is to present the ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) findings in a case of left adrenal adenoma with a coincidental RLRV and to discuss the clinical importance of their imaging. Abdominal and scrotal US, abdominal CT and MRI were performed for a 50-year-old male patient who was referred with continuous abdominal pain, intractable hypertension, high levels of blood cortisol and proteinuria. On US, a hypoechoic solid mass measuring 4 × 3 cm in the left adrenal location and coincidental RLRV, besides multiple renal cysts, hepatomegaly, left-sided varicocele, and small-sized left testis were detected. CT and MRI also revealed the mass in the left adrenal gland which was consistent with adenoma. With CT and MRI, presence of RLRV was also verified.

Fatherhood in Tall Men Treated with High-Dose Sex Steroids during Adolescence

Sex steroid treatment to reduce final height of tall boys has been available since the 1950s. In women, it has been shown to interfere with fertility. In men, no such data are available. We therefore evaluated fertility and gonadal function in tall men who did or did not receive high-dose androgen treatment in adolescence. We conducted a retrospective cohort study of 116 tall men, of whom 60 had been treated. Reproductive and gonadal function was assessed by standardized interview, semen analysis, endocrine parameters, ultrasound imaging, and fatherhood. Mean age at treatment commencement was 14.2 yr, and mean follow-up was 21.2 yr. Sixty-six men (36 treated and 30 untreated) had attempted to achieve fatherhood. The probability of conceiving their first pregnancy within 1 yr was similar in treated and untreated men (26 vs. 24; Breslow P=0.8). Eleven treated and 13 untreated men presented with a left-sided varicocele (P=0.5). Testicular volume, sperm quality, and serum LH, FSH, and inhibin B levels were comparable between treated and untreated men. However, treated men had significantly reduced serum T levels, adjusted for known confounders [mean (sd) 13.3 (1.8) vs. 15.2 (1.9) nmol/liter; P=0.005). In addition, testicular volume and serum inhibin B and FSH levels in treated men were significantly correlated with age at treatment commencement. At a mean follow-up of 21 yr after high-dose androgen treatment, we conclude that fatherhood and semen quality in tall treated men are not affected. Serum testosterone levels, however, are reduced in androgen-treated men. Future research is required to determine whether declining testosterone levels may become clinically relevant for these men as they age.

Hypoxia‐Induced Apoptosis in the Bilateral Testes of Rats With Left‐Sided Varicocele: A New Way to Think About the Varicocele

Although the varicocele has been studied for many years, its pathophysiology remains unclear. In this study, we investigated the expression of the alpha subunit of hypoxia-inducible factor 1 (HIF-1 alpha) and determined the apoptosis index (AI) in the testes of rats with varicoceles to study the mechanism by which varicoceles induce infertility. A total of 45 Wistar rats were divided into 3 groups: control group, sham surgery group, and experimental group. Forty-nine days after the initial partial ligation of the left renal vein, all of the rats underwent orchiectomy. HIF-1 alpha expression in each testis was analyzed using immunohistochemical methods and enzyme-linked immunosorbent assay. The degree of apoptosis within each testicle was determined using terminal deoxynucleotidyl transferase dUTP nick end labeling. HIF-1 alpha immunoreactivity in the testes of the experimental group was significantly higher than that in those of the control group (P < .05) or the sham group (P < .05). The AI of the germ cells of rats in the experimental group was significantly higher than that in germ cells of rats in the sham group (P < .001) or the control group (P < .001). Additionally, there was a significant positive correlation observed between the AI of germ cells and relative intensity of HIF-1 alpha in the left testis (r = .631; P = .028) and right testis (r = .707; P = .01) of rats in the experimental group. The results of this study showed that a left-sided varicocele could cause bilateral testicular hypoxia and increased germ cell apoptosis, both of which play an important role in testicular dysfunction. Furthermore, HIF-1 alpha is a useful factor that can be used to predict the degree of germ cell apoptosis in rat testes.

Does G Force Increase the Incidence of Varicocele in Air Force Pilot Cadets?

Objective: Air Force pilots are subjected to acceleration (G) forces with a known effect upon the vascular system. Specific training and anti-G maneuvers are used to counteract this effect, and allow pilots to operate at the limits of human endurance. The objective of the present study is to determine whether acceleration affects the incidence of varicocele. Subjects and Methods: The incidence of varicocele during training in 234 Air Force pilots was assessed. Height, weight, BMI and testicular volume were recorded for every participant. A group of 35 pilots with an absence of varicocele, randomly selected, acted as the control group. Results: Left-sided varicocele was confirmed in 23 (9.8%) pilots. Affected pilots tended to be taller (p = 0.073) and had a smaller mean left testicular volume (p < 0.001) than the control group. Eight cases (35%) were grade I, 10 (43%) were grade II, and 5 (22%) were grade III. For grades I and II, there was a trend for the testicular volume to decrease (p = 0.349 and 0.067, respectively). In grade III varicocele, this difference was statistically significant (p < 0.05). Conclusions: The incidence of varicocele in fighter pilots during training is not higher than in other groups of the same age. Affected individuals tend to be taller, with ipsilateral testicular hypotrophy.

Diagnosis and Surgical Treatment of Nutcracker Syndrome: A Single-Center Experience

Conclusion: Left renal vein transposition is an efficient surgical treatment for nutcracker syndrome. In some cases however pelvic pain remains following left renal vein transposition. Summary: The nutcracker syndrome is an unusual problem where the left renal vein is narrowed as it passes between an angle formed between the abdominal aorta and the superior mesenteric artery. This narrowing of the left renal vein can lead to increase venous pressure within the renal circulation and promote development of varices of the renal pelvis and ureter with resulting hematuria. Other symptoms associated with nutcracker syndrome include orthostatic proteinuria, flank pain, left-sided varicocele, pelvic congestion, and chronic fatigue. The authors retrospectively reviewed 23 patients with the diagnosis of nutcracker syndrome treated at their institution from July 1998 to July 2007. Nutcracker syndrome was suspected based on the combination of clinical examination, ultrasound, CT imaging, and MRI imaging. Hematuria was the most common presenting symptom (21 of 23 patients). One patient presented with orthostatic proteinuria and 1 with pelvic congestion syndrome. No patient had renal function deterioration and 13 of 23 undergoing cystoscopy had bleeding noted from the left ureteral orifice. Only 7 underwent transposition of the left renal vein with the indication of transposition being recurrent gross hematuria in 6 patients and persistent orthostatic proteinuria in 1 patient. Sixteen patients who had more mild symptoms were followed without operation. Patients with microscopic hematuria or intermittent short periods of painless gross hematuria were followed closely without treatment. Patients with flank or abdominal pain were treated with low-dose aspirin treatment. Four women with pelvic congestion syndrome were treated with medroxyprogesterone acetate. Patients undergoing left renal vein transposition did so through a mid-line abdominal incision with mobilization of the left colon and small bowel to give access to the retroperitoneum. The inferior adrenal vein, ovarian/testicular vein, and the lumbar vein draining into the left renal vein were ligated and transected. The left renal vein was excised with the small rim of vena cava and injected with heparin. Reanastomosis was then performed to a more caudad portion of the inferior vena cava. All 7 patients treated with renal vein transposition had normal pre-operative creatinine levels with no increase following renal vein transposition. Hematuria and proteinuria ceased spontaneously 5 to 14 days following surgery with no clinical relapses. Of the 16 patients treated conservatively, clinical improvement occurred in 11 with total relief of symptoms in 2 patients and partial relief in 9 patients. There was no relief of symptoms in 5 patients following a mean follow-up of 41.2 months. Comment: The pressure gradient between the left renal vein near the renal hilum is normally between 0 and 1 mmHg (J Urology 1982; 127: 1070-1071). An elevated gradient of more than 3 mmHg between the left renal vein and the vena cava is used as a criteria to diagnose nutcracker syndrome. All patients in this series had such a gradient. The study indicates that left renal vein transposition works well to alleviate symptoms in patients with nutcracker syndrome and elevated renal vein IVC pressure gradients. Equally important is that patients with mild symptoms do well treated conservatively. It would appear reasonable to reserve surgical treatment of nutcracker syndrome to those patients with recurrent gross hematuria or persistent orthostatic proteinuria who are not responsive to conservative management. The authors also point out that children and adolescents can have nutcracker syndrome that will frequently resolve as the child matures into adulthood. Surgical treatment of nutcracker syndrome in children and adolescents therefore, in most cases, should be avoided.

Lymphatic sparing laparoscopic Palomo varicocelectomy for varicoceles in children: intermediate results

Objectives Varicocele is a relatively rare disorder in children that can lead to testicular atrophy and infertility. The ideal surgical treatment for varicoceles is still a matter of controversy because of the frequency of postoperative complications. Here, we report our series of children who underwent lymphatic sparing laparoscopic Palomo varicocelectomy. Patients and Methods A total of 46 boys, 9 to 14 years old, underwent laparoscopic repair for varicoceles between January 2002 and December 2007. All of them had a left-sided varicocele. The varicocele was diagnosed by physical examination and Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the lymphatic vessels, followed by double ligation of the spermatic vessels. Follow-up for these children included physical examination and Doppler ultrasonography. Results Lymphatic sparing laparoscopic Palomo varicocelectomy was feasible in all 46 (100%) of the children. Mean operative time was 34.2 minutes (range, 25-42 minutes). There were no intraoperative complications. One patient recurred because of incomplete ligation of spermatic vein. Mean follow-up was 20 months (range, 7-32 months). Hydrocele formation, testicular atrophy, and testicular hypertrophy were not observed postoperatively. However, 2 preoperative hypotrophic testes were noted with 10.4% and 12.5% decreases in size. Conclusions Our study reveals that lymphatic sparing laparoscopic Palomo varicocelectomy in children is safe, effective, and the reliable treatment of pediatric varicocele. However, long-term follow-up is required to best characterize ultimate outcome.

Preserved testicular artery at varicocele repair

Whether or not varicocele causes infertility is a contentiously debated issue. This study aimed to compare semen parameters and pregnancy rate in infertile males who underwent varicocelectomy with preserved or accidentally ligated testicular artery. Ninety-five infertile oligoasthenozoospermic patients with left-sided varicocele were subjected to subinguinal varicocelectomy with trial of preserving testicular artery. According to absence or presence of testicular artery in the histological excised pedicle the cases were divided into two groups; group 1 (n = 60) with preserved testicular artery and group 2 (n = 35) where the artery was accidentally ligated being not defined or injured. Semen analysis was carried out after 4, 8 and 12 months and post-operative pregnancy rate was assessed after 1 year. Serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone (T) were estimated pre- and post-operatively. Semen parameters (total sperm count, sperm concentration and sperm motility) showed significant increase post-operatively compared with pre-operative parameters but were comparable in both groups with no significant difference. Serum FSH, LH, T hormones and pregnancy rate (23.3% versus 22.9%) 1 year post-operatively showed no significant difference. It is concluded that accidental ligation of testicular artery has no deleterious effect on semen parameters during primary varicocele repair if the testicular arterial supply was not compromised.

Kallikrein Therapy of Infertile Men with Varicocele and Impaired Sperm Motility: Therapie mit Kallikrein bei infertilen Männern mit Varicocele und reduzierter Spermatozoenmotilität

A randomized group of 65 men with oligoasthenozoospermia and left side varicocele was subjected to a controlled study with kallikrein. Kallikrein (600 units orally per day) was given to 38 men for a period of 3 months. The other group of 27 men remained untreated but were followed up during the same period of time. After kallikrein treatment significant improvements in sperm quality could be observed: percentage of motile spermatozoa from 24.47 +/- 9.01 to 35.26 +/- 11.80, percentage of morphologically normal spermatozoa from 58.42 +/- 5.86 to 71.05 +/- 8.12. There was no improvement in sperm parameters in the untreated group of men. The results suggest that kallikrein therapy is useful for those men who refuse an operative or radiologic treatment of their varicocele and also as a primary or associated therapy of patients who underwent ligature or occlusion of spermatic veins.

The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele

To assess the improvement of seminal characteristics and pregnancy rates after microsurgical varicocelectomy in men with subclinical varicocele. Retrospective study. University infertility clinic. One hundred forty-three patients with a subclinical left-sided varicocele. Patients who agreed to microsurgical varicocelectomy (n = 25, surgery group), medical treatment with L-carnitine (n = 93 drug group), and those who did not agree to any treatment (n = 25, observation group) were enrolled. Semen characteristics were reevaluated twice 6 months after treatment. The natural pregnancy rates were estimated by telephone interview between 1 and 2 years after treatment. In the surgery group, sperm counts improved significantly after microsurgical varicocelectomy. In the drug group, however, sperm parameters did not significantly improve after treatment. Natural pregnancy rates were 60.0% in the surgery group, 34.5% in the drug group, and 18.7% in the observation group. The natural pregnancy rate of the surgery group was higher than the other groups, and there were statistically significant differences among the three groups. Surgical treatment is the best option for management of subclinical varicocele.

Effect of Varicocele on Testicular Volume

Varicocele is one of the common causes of male infertility and is characterized by an anomalous dilation of the veins of the pampiniform plexus. There are many researches reported about ipsilateral testis volume reduction in varicocele in the literature. There are few researches reported about the effect of varicocele to the contralateral testis and different results have been reported unlike each other, as some reports say that an increase in contralateral testicular volume in varicocele, the others say reduction in contralateral testicular size. In our study we aimed to detect the effects of varicocele on bilateral testicular size. The study included 89 adult patients that had undergone routine scrotal CDUS and diagnosed with only left-sided varicocele. 51 patients which have no varicocele and any other anomaly with testis were chosen for the control group. The patients diagnosed with varicocele gathered into groups as grade 1, grade 2 and grade 3. The difference between bilateral testis volume was calculated by the formula; [(right testis volume-left testis volume) / right testis volume x 100] in all patients. Right and left testis volumes, volume differences between testes among all groups (control, grade 1, grade 2 and grade 3 groups), and right and left testis volumes in each group were compared. No significant difference was established statistically in comparision of testis volumes in each group, and right and left testis volumes and differences between testes volumes within groups. In conclusion, our study established that there is no effect on testis volume in varicocele.

Laparoscopic Management of Varicocele Using Bipolar Cautery Versus Open High Ligation Technique: A Randomized, Clinical Trial

The aim of this investigation was to compare laparoscopic management of varicocele using bipolar cautery with open high ligation technique. A total of 100 patients were operated on for left-sided varicoceles. To evaluate the clinical efficiency of the treatment, the patients were divided randomly into two groups. A laparoscopic varicocelectomy (LV) was performed on 50 patients, and an open varicocelectomy (OV) was performed on 50 patients. Outcome data examined operating time, relapse rate, presence of hydrocele, wound complications, postoperative length of stay, and pain control. In both groups, the operations were performed with the preservation of lymphatics and artery with ligation of the veins in the retroperitoneum above the internal inguinal ring. The operative time was 17.2 +/- 9.8 minutes in LV versus 31.02 +/- 12.8 minutes; in OV (P = .00). In LV versus OV, relapse rates were 8% versus 4% (P > 0.05), hydrocele occurrence was 14% versus 24% (P > 0.05), and wound complication was 0.00% versus 6%. Hospital stay was an average of 12 hours in both groups. Postoperative analgesic use was 3.6 +/- 0.4 mg in LV versus 3.5 +/- 0.5 mg in OV (P > 0.05). The clinical efficacy of LV using bipolar cautery is superior to traditional OV.

Percutaneous Embolization of a Left-sided Varicocele in a Patient with a Duplicated Inferior Vena Cava

Anatomic variants of the inferior vena cava (IVC) can make selective catheterization of the spermatic vein difficult. In an attempt to embolize the left varicocele, the authors identified a duplicated IVC on an initial venogram through the right common femoral vein. However, it was not possible to cannulate the left spermatic vein with this conventional approach, necessitating an approach from the right internal jugular vein. The left varicocele was successfully embolized.

Combined effects of the experimental left varicocele and lead or nicotine on the rat testis

Combined effects of the experimental left varicocele and lead or nicotine on the rat testis

Altered serum inhibin b levels in adolescents with varicocele

Background/Purpose Different studies have evaluated testicular hormonal dysfunction in adolescent varicocele but with variable results. Recently, inhibin B has been proposed as a marker for spermatogenesis and Sertoli cell function. The aim of the present study was to study in a homogeneous cohort of adolescents inhibin B and other hormones to detect whether untreated varicocele may be associated with any modifications of these factors. Methods Sixteen adolescents (mean age, 14.5 ± 1.0 years), at Tanner stages 4 to 5 with grade II or III left-sided varicocele, underwent hormonal evaluation of inhibin B, basal testosterone, and both baseline and GnRH stimulated FSH and LH levels. Thirteen unaffected adolescents of age-matched and pubertal development were used as controls. Results Patients with varicocele showed a significant reduction in the testicular volume of the affected side (13.3 ± 4.1 vs 15.8 ± 4.8 mL; P = .002) and significant reduced levels of inhibin B compared with controls (271.9 ± 70.2 vs 327.1 ± 34.9 pg/mL; P = .042). Inhibin B levels were significantly correlated with testes volume ( r = 0.62; P = .0097). Other hormonal parameters were similar in both varicocele and control groups. Conclusion Inhibin B is reduced in adolescents with untreated varicocele, and it is positively correlated with testicular volume. This could be an early marker for Sertoli cell damage, with possible implications for spermatogenesis and could represent a new indication for varicocele repair.

Significance of sperm characteristics in the evaluation of adolescents, adults and older men with varicocele

No reports have been published about age-related sperm malformations in varicocele patients. To investigate the distribution of abnormal sperm characteristics in adolescents, adults and older men with varicocele. Records of semen analysis of 143 men aged 14 to 53 years who had evident left-sided varicocele detected by physical examination and confirmed by doppler sonography were selected. Sperm concentration, vitality, motility, morphology, hypoosmotic swelling test (HOST) and morphology were measured in adolescent males aged 14 to 20 years (n=31), men 21 to 30 years (n=48), 31 to 40 years (n=40) and older men over 40 (n=24) and compared with a control group of fertile men with no varicocele (n=27) and with a group of infertile men with varicocele (n=26). One-way analysis of variance and the Kruskal-Wallis test were used to compare varicocele groups. Comparisons with the control group and infertile group were performed using the unpaired t-test and the Mann-Whitney test. The discriminating ability of significant sperm characteristics in evaluating the sperm quality of varicocele men was also analyzed using receiver operating characteristics curve to select the cut-off level providing the best combination of sensitivity and specificity. Varicocele men displayed similar impairment of vitality, motility and HOST. Sperm morphology analysis revealed a prevalence of small head, slightly and severely amorphous head and particularly combined anomalies in the study groups. Sperm concentration fell within the normal range of the World Health Organization manual. Differences were not significant between the study groups and when compared with infertile group ( P> 0.005). However, a comparative study of the varicocele groups and the infertile group with the control group revealed significant differences in sperm vitality, motility, HOST, morphologically normal sperm, pin-headed, tapered and combined anomalies. Morphologically normal sperm and combined anomalies showed higher accuracy in identifying poor sperm quality in varicocele men (83.7% and 77.9%, at cut-off levels of 9% and 38%, respectively). Varicocele harms equally the sperm characteristics of adolescents, adults and older men. Apparently, it affects sperm quality more adversely than it does sperm production.

Baseline follicle‐stimulating hormone is a strong predictor for the outcome of the gonadotrophin‐releasing hormone test in young men with unilateral medium‐ or high‐grade varicocele

To investigate whether the gonadotrophin-releasing hormone (GnRH) test is an adequate diagnostic tool to identify testicular dysfunction in men with strictly unilateral varicocele and defined testicular volume; and to identify any peripheral venous variable which would predict the result of the GnRH test. In all, 102 GnRH tests were done in men with a left-sided varicocele. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were determined. After intravenous administration of 100 microg GnRH, stimulated LH and FSH levels were measured. FSH levels of >8.2 U/L and LH levels of >51.7 U/L were considered exaggerated. In all, 50 men had an exaggerated GnRH test result; all had an exaggerated FSH response and six also had an elevated LH response. The baseline FSH levels were higher (P < 0.001) and the testicular volume was smaller (P < 0.01) in men with an exaggerated GnRH test response. All men with a baseline FSH level of >5.6 U/L had an exaggerated GnRH test response. A baseline FSH level of >5.6 U/L is a good predictor of the GnRH test outcome. Leydig cell function seems mainly undisturbed.

Varicocele, Hypoxia and Male Infertility. Fluid Mechanics Analysis of the Impaired Testicular Venous Drainage System

BACKGROUND: Varicocele is a bilateral vascular disease, involving a network of collaterals and small, retroperitoneal bypasses. The right and the left testicular venous drainage systems are complex and not identical to each other. It was considered a predominantly unilateral (left-sided) disease. Its pathophysiology has not been clearly delineated and the treatments offered do not seem to be effective. The medical literature is replete with articles demonstrating inconsistent and even contradictory results which have led clinicians to dissociate varicocele from male infertility. Since male fertility is preserved with only one healthy testis, male infertility perforce represents bilateral testicular dysfunction. This poses an enigma to clinicians: How can left-sided varicocele causes bilateral testicular dysfunction? METHODS: We investigated the internal spermatic veins by venography to understand testicular damage due to varicocele. A total of 740 venographies of the internal spermatic veins (ISVs) were performed, with sclerotherapy of the ISV as treatment for varicocele. Epon-embedded testicular tissue sections were used to identify blood stagnation in the testis. RESULTS: Varicocele is predominantly a bilateral disease in 84% of cases, associated with collaterals and retroperitoneal venous bypasses in 70% in the left side and 75% in the right side. Histopathology demonstrate stagnation in the testicular microcirculation and hypoxic-ischaemic degenerative changes in all cells’ types in the sperms’ production site. CONCLUSION: Based on our findings (i) varicocele is a bilateral disease; (ii) the disease is expressed earlier in the left side and is more intense because the blood column is longer in the left side than the right; (iii) partial treatment to the left side only and ignoring bypasses is not adequate to correct the problem; (iv) hypoxia leading to ischaemic damage to both testes is the effect of varicocele due to hydrostatic pressures in the impaired venous drainage system, which exceeds the pressures in the testicular arterial microcirculation due to blood columns produced in the disease; (v) hydrostatic pressure does not depend on vein diameter but on blood column height, only; and (vi) thermography alone or combined with ultrasonography with special attention to the bilaterality of the disease are the best non-invasive tools for its detection.

Managing Varicoceles in Children: Results With Microsurgical Varicocelectomy

Authors from New York present their experience of elective varicocelectomy, using microsurgical techniques, in a large series of children. They found the procedure to be safe and effective, and gave a much lower complication rate than the published rate in open varicocelectomy. The results of urethroplasty in post-traumatic paediatric urethral strictures are presented by authors from Mansoura. They found the overall success of one-stage perineal anastomotic repair of such strictures to be excellent, with very little morbidity. OBJECTIVE To report our experience of microsurgical subinguinal varicocelectomy in boys aged ≤ 18 years. PATIENTS AND METHODS Boys aged ≤ 18 years treated with microsurgical varicocelectomy between 1996 and 2000 at one institution were retrospectively reviewed. Indications for surgery included ipsilateral testicular atrophy, large varicocele or pain. Microsurgery was assisted by an operating microscope (×10–25) allowing preservation of the lymphatics, and the testicular and cremasteric arteries. Patient age, varicocele grade, complications and follow-up interval were recorded. RESULTS In all there were 97 microsurgical subinguinal varicocelectomies (23 bilateral) in 74 boys (mean age 14.7 years). Left-sided varicoceles were significantly larger (mean grade 2.9) than right-sided (mean grade 1.4) varicoceles. The mean follow-up was 9.6 months. There were four complications: two hydroceles, of which one resolved spontaneously after 4 months; one patient had persistent orchialgia that resolved after 8 months; and one developed hypertrophic scarring at the inguinal incision site. There were no infections, haematomas or intraoperative injuries to the vas deferens or testicular arteries. All boys were discharged home on the day of surgery. CONCLUSIONS Microsurgical subinguinal varicocelectomy in boys is a safe, minimally invasive and effective means of treating varicoceles. Compared with published results of the retroperitoneal mass ligation technique, which has a 15% overall complication rate and a 7–9% hydrocele occurrence rate, the microsurgical subinguinal approach appears to offer less morbidity, with a 1% hydrocele rate. We consider that microsurgical subinguinal varicocelectomy offers the best results with lower morbidity than other techniques.