Veins Of Pampiniform Plexus Research Articles

Association between left-sided varicocele and epididymo-orchitis with sonographic findings.

The aim of this study was to investigate the relationship between left-sided varicocele and epididymitis or epididymo-orchitis. The study included 72 patients with left side epididymitis (EP) or epididymo-orchitis (EPO) (Group 1) and a control group of 72 patients without EP or EPO (Group 2). Those with right EP-EPO were excluded due to possible other underlying retroperitoneal pathologies causing varicocele. Groups were evaluated for presence of left side varicocele, varicocele grade and pampiniform plexus vein diameter. The average age was 38 ± 8.4 years (range, 18-50 years) in Group 1, and 36 ± 9.1 years (range, 16-47 years) in Group 2. Varicocele was significantly more common in patients with EP or EPO (p < 0.001). The rate of varicocele was 66.7% (48/72) in Group 1, and 22.3% (16/72) in Group 2. The median grade of varicocele was 2 in Group 1, and 0 in Group 2. Pampiniform plexus vein diameters were found to be significantly larger in patients with EP or EPO compare to patients without EP and EPO. The median vein diameter was 3.3 mm with the 25th and 75th percentiles at 2.7 and 3.8 mm, and was 1.9 mm with the 25th and 75th percentiles at 1.7 and 2.3 mm, respectively (p < 0.001). Left-sided varicocele was significantly more common in patients with EP or EPO and it is an important cause for the development of EP/EPO because of chronic venous stasis.

Lipidomic analysis of seminal plasma in work-up of varicocele-associated male infertility

Background. Approximately 50 % of cases of infertility in couples are attributable to male factor. One of the most common causes of male infertility is varicose dilation of pampiniform plexus veins in spermatic cord, or varicocele. However, the fact that only in 10-45 % of cases microsurgical subinguinal varicocelectomy leads to a spontaneous pregnancy in a couple urges further search for a diagnostic marker which would be able to predict the success of surgical treatment of varicocele preoperatively.Aim. To study the features of lipid profile of seminal plasma in patients with varicocele and to evaluate the possibility of using lipidomic analysis of seminal plasma for patient selection prior to surgical treatment for varicocele.Materials and methods. Fifty three patients from infertile couples with varicocele and altered seminal parameters aged 18 to 44 years underwent microsurgical varicocelectomy as described by Marmar. All patients were treated in one department. The control group included 24 healthy normozoospermic men without varicocele who had proven fertility. The material for the study was the seminal plasma of men, lipid composition of which was determined by mass spectrometry.Results. No significant differences were found in lipid profiles of seminal plasma from men in control group and varicocele group, as well as in lipid profiles of seminal plasma obtained before and after surgery in same patients. Comparison of lipid profiles of seminal plasma provided by patients before microsurgical varicocelectomy, who had clinical effect (n = 15) and who did not have clinical effect (n = 16), revealed differences in level of HexCer-NDS d20:0/18:0 in the positive ion test and in levels of 8 other lipids in the negative ion test. These lipids are related to the oxidation of phospholipids, cardiolipins and phosphatidylethanolamines.Conclusion. The lipid profile of seminal plasma of patients who had clinical response to varicocele surgery is significantly different from the lipid profile of seminal plasma of non-responder patients.

Evaluation of cytokine profile of ejaculate in adolescents with varicocele

Varicocele is a vascular disease characterized by abnormal tortuosity and dilation of the veins in pampiniform plexus that drains the testis. Due to difficult outflow of blood via the altered veins, the intratesticular blood flow becomes impaired, leading to pathological changes in the testicular tissue caused by hyperthermia, ischemia, hypoxia and development of inflammatory reaction. Seminal plasma contains numerous proteins, molecules, a wide range of cytokines, chemokines, growth factors. Their properties and levels largely determine the stages of post-testicular maturation of spermatozoa. At the same time, cytokines are an integral part of the inflammatory effect and are synthesized by various immunocompetent cells present in the male reproductive tract. Increased cytokine levels in ejaculate may act as a marker of local inflammatory process, being a significant factor of male infertility. The purpose of our study was to assess cytokine profile of ejaculate in adolescents with varicocele.The level of cytokines IL-1β, IL-6, IL-8, TNFα, IL-4, IL-10, VEGF was determined in ejaculate of adolescents aged 17 years. The main group consisted of 100 adolescents with II-III degree varicocele; the comparison group included 30 adolescents without varicocele.Adolescents with varicocele have statistically higher levels of all studied pro-inflammatory cytokines, except of IL-8 and IL-10, which may suggest presence of a local inflammatory process. We did not find significant differences in the levels of cytokines between groups with grade II and III varicocele. However, the levels of pro-inflammatory IL-1β, IL-6 cytokines in ejaculate proved to be increased in the patients with grade III varicocele. When comparing the results between both groups, depending on the period after varicocelectomy and in the comparison group, statistically higher levels of IL-1β, IL-6, TNFα were detected in patients with more recent surgical correction and IL-10 levels in both subgroups with varicocele. This finding, given the progressive course of this disease, may be considered an unfavorable factor, since the pro-inflammatory status of testicular tissue returned, at later terms after surgery.In adolescentswith varicocele, increased levels of pro-inflammatory cytokineswere revealed in the ejaculate. There were no statistically significant differences in the level of cytokines in ejaculate of the patients with II and III degrees of varicocele. At the longer postsurgical period, an increased level of pro-inflammatory cytokines was revealed in the ejaculate samples.

Echocardiographic and hemodynamic changes in patients with high-grade varicocele.

Varicocele is abnormal tortuosity and dilatation of the pampiniform plexus veins within the spermatic cord. Varicocele is associated with testicular atrophy, hypogonadism, impaired semen analysis values, or decreased testosterone production. Varicocele is a progressive disease and should be treated because it may be a systemic disease that can be associated with cardiovascular abnormalities. We hypothesize in this study that cardiovascular and hemodynamic pathologies may occur in varicocele patients. In this prospective, multicentric, multidisciplinary study, patients diagnosed with high-grade left varicocele in the urology clinic underwent semen analysis, total testosterone determination, and scrotal Doppler ultrasonography. In addition, blood pressure measurement and echocardiographic evaluation were performed by blinded cardiologists in both the varicocele patients and the healthy control group. The study was carried out with 103 varicocele patients and 133 healthy individuals who formed the control group. Diastolic blood pressure (P = 0.016), left ventricular end diastolic (P < 0.001) and systolic diameter (P < 0.001), ejection fraction (P < 0.001), pulmonary arterial pressure (P < 0.001), and aortic distensibility (P < 0.001) values were significantly higher in varicocele patients compared with controls; interventricular septum wall thickness (P = 0.022), aortic systolic (P < 0.001) and diastolic diameter (P < 0.001), aortic systolic (P < 0.001) and diastolic diameter index (P < 0.001), and aortic stiffness index (P < 0.001) values were significantly lower in varicocele patients. The mean aortic distensibility of non-normozoospermic group was lower than that of normozoospermic group (P = 0.041). There was no statistically significant relationship between thickest vein diameter in spermatic cord and cardiological parameters. This study showed that symptomatic patients with high-grade varicocele had a higher risk of cardiovascular and hemodynamic disease. We recommend that men with high-grade symptomatic varicocele with impaired semen analysis undergo cardiovascular and hemodynamic evaluation regardless of their spermatic vein diameter.

Role of endovascular intervention in the treatment of primary varicocele

Varicocele are dilated tortuous veins of the pampiniform plexus—the venous sinuses that drain the testicles. These sinuses primarily drain into the internal spermatic vein (gonadal vein). The aim of this work was the assessment of the results of endovascular treatment of primary varicocele by embolization of the internal spermatic vein and pampiniform plexus of veins, as regard to its advantages over the traditional methods, disadvantage, efficiency and recurrent rate in an attempt to choose the best method for treatment of primary varicocele with least complication and highest success rate. This prospective randomized study was conducted on 30 patients with primary varicocele by endovascular treatment of primary varicocele through embolization of the internal spermatic vein and pampiniform plexus of veins under local anesthesia. The study was conducted in the department of vascular surgery, Al- Azhar University Hospitals – Cairo (Al-Hussein and and said-Galal University Hospitals). 90% of the patients showed post procedural normal duplex and 86.7% of the patients showed improvement of semen analysis. our study confirms that the embolization method presents a low complication rate and a higher success rate. T

Sperm DNA damage and cytokines in varicocele: A case-control study.

Varicocele is a vascular disease characterised by the abnormal enlargement of the pampiniform plexus veins and a well-known cause of male infertility. The aim of this study was to investigate the relationship between sperm DNA fragmentation (SDF) and inflammation in the pathogenesis of varicocele. We included 84 varicocele patients and 85 normozoospermic healthy controls, further analysed according to the body mass index, the smoking habit (smokers/non-smokers) and the varicocele severity (low/high grade). Semen parameters, SDF (by TUNEL) and inflammatory cytokines (by Luminex xMAP analysis) were evaluated. Varicocele patients showed significantly reduced semen parameters (volume, total sperm number, progressive motility, normal morphology) and increased SDF. Moreover, we observed a significant reduction of IFN-γ, IL-6, TNF-α and an increase of IL-10. No difference was reported according to the smoking habit, body mass index and varicocele severity. The observed cytokines pathway suggests the establishment of a chronic inflammatory condition, which may contribute to the alteration of semen quality. A thorough knowledge of the cytokine network might contribute to better understanding the link between inflammation and semen quality in varicocele and its impact on reproductive health.

Results of Adults Laparoscopic Varicocelectomy in a Limited Setting: A Study in Yaound&amp;#233; (Cameroon)

Background: Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus veins draining the testicle. The principle of varicocele treatment is to block the reflux in the internal spermatic vein while preserving the internal spermatic artery, lymphatics and vas deferens. Treatment can be performed through percutaneous venous embolization or surgical correction, either open or laparoscopic approach. The purpose of the study was to review our experience in the management of laparoscopic varicocele repair and to assess the outcomes after operation. Methods: We retrospectively reviewed files of patients who underwent laparoscopic varicocelectomy from January 2010 to December 2009 in three health center of Yaoundé (Cameroon). Clinical and diagnosis features of varicocele, indication for surgery, operative procedure and outcomes, as well as long-term follow-up of were analyzed. Results: A total of 74 file of patients were collected. The average age of patients was 36.93 years old. Among them, 43 (58.11%) had varicocele grade 1, 21 (28.38%) grade 2, and 2 (2.70%) grade 3. Fifty-four (72.97%) cases had bilateral varicocele, 17 (22.97%) and 3 (4.05%) patients had left and right varicocele respectively. 42(56.7%) patients complained for fertility problem. Scrotal pain was found in 26 (35.13%) cases. The pneumoperitoneum was achieved in all cases through a supra-umbilical open coelioscopy with the insertion of a 10 mm-optic port. Two 5 mm working ports were used in all cases. Dilated veins were clipped without section simple in 56 cases (75.68%). the mean operative time was 31.9 min ± 8.6 min. With a mean follow-up period of 27 months, we recorded 4.05% of recurrence and hydrocele in 1 case (1.35%), symptoms’ regression in 87% of cases and pregnancy in 65.9% of cases of infertility. Conclusion: Laparoscopic varicocelectomy is feasible and safe in our setting, with good results. We emphasize this approach in even in low setting like our own.

Curated findings and implications in duplex ultrasound interrogation of the scrotum or varicoceles

The purpose of this study was to curate clustered findings of duplex ultrasound in the evaluation of spermatic venous varicoceles, and deliver more responses to the present concerns. Archives of 979 men who had undergone scrotum and spermatic venous plexus duplex ultrasound were reviewed. In the duplex ultrasound interrogation, the sizes of the larger vessels of the spermatic venous plexus, peritesticular vessels, and testicular volume and relevant parameters were measured. Findings of the vessels were analyzed. One hundred and eight-one out of 979 patients had varicoceles. Color Doppler flow signal was rendered in veins of pampiniform plexus but not in peritesticular vessels in 501 out of 979 patients; 101 out of 501 patients had veins of pampiniform plexus ≤ 3 mm, no color Doppler flow signal could be rendered in the veins in the 101 patients at supine and standing positions without Valsalva maneuver, color Doppler flow signal could be rendered in the veins in 82 out of 101 patients at supine and standing positions with Valsalva maneuver; no color Doppler flow signal could be rendered in the veins from 19 out of 101 patients with and without Valsalva maneuver at supine and standing positions. 37 out of 979 patients with 61 ipsilateral testicular volume ≤ 5 mL had no vessel diameter > 2 mm. The incidences of varicoceles corresponding to different ranges of testicular volume of 1–5 mL, 5.1–10 mL, 10.1–15 mL, 15.1–20 mL, 20.1–25 mL, and 25.1–30 mL were 0.0%, 6.9%, 8.3%, 6.63%, 20.94%, and 59.1%, respectively. The comparisons of incidences of varicocele between distribution percentages of different ranges of testicular volume of 1–5 mL and others (of 5.1 mL and more) were all significant (all P < 0.05). The correlation coefficient between the different ranges of testicular volume and the incidence of varicoceles was 0.829. Increased testicular volume may be also a factor for the development of varicoceles. Dilated peritesticular vessels may be collateral veins of spermatic veins, anterior and posterior scrotal veins, or proximal vas deferens.

Right-sided scrotal varicocele and its association with malignancy: a multi-institutional study.

To determine the prevalence of isolated right-sided varicocele due to an obstructing malignancy in patients with no other evidence of malignancy. This retrospective, multi-institutional study included a text search for right-sided varicocele in consecutive reports of scrotal ultrasound studies performed between 4/22/1999 and 06/24/2018. Diagnosis was confirmed by a radiologist based on the following criteria: pampiniform plexus vein diameter of ≥ 2mm, which has augmented flow or increases by ≥ 1mm on Valsalva. Inclusion criteria for adequate follow-up were (1) abdominopelvic CT or MRI performed within 3months prior to, or any time after, the ultrasound study; or (2) presence of clinical documentation more than 2years after the ultrasound date. Exclusion criteria were existing cancer diagnosis in the abdomen or pelvis, epididymo-orchitis, intratesticular or intrascrotal mass, and prior scrotal surgery. Images of available CT or MRI studies were reviewed for presence of any explanation of right-sided varicocele. 210 patients with right-sided varicocele met inclusion and exclusion criteria. 118/210 had abdominopelvic CT or MRI in the assigned timeframe. Of these, no patients had malignancy that could account for right-sided varicoceles. Of the 92/210 patients without CT or MRI but with available clinical follow-up, none had a malignancy that could have caused an isolated right-sided varicocele. There was no underlying malignancy to explain the right-sided varicocele in any of the patients, 0/210, 95% CI [0.0-1.4%]. No associated malignancy was found in patients with isolated right-sided varicoceles to support additional imaging for malignancy screening.

AN EPIDEMIOLOGICAL STUDY OF VARICOCELE

Background: Varicocele, an abnormal dilatation and tortuosity of the pampiniform plexus of veins is found in about 15% of the general population with a marked left sided predominance. However this incidence rises to 35% in men with primary infertility and 70 to 80% in men with secondary infertility.&#x0D; Methods: Hospital based prospective study conducted on 100 cases reporting to General surgery department within the study duration and eligible as per inclusion criteria was included in study.&#x0D; Results: In our study out of Out of 100 patients maximum 42.00% patients were farmer followed by 22.00% patients were Coolies and Rickshaw Pullers, 17.00% patients were students, 10.00% were laborer and 9.00% were policemen.&#x0D; Conclusion: It conclude that Varicocele epidemiology remains incompletely understood. We need well‑designed, large‑scale studies that include evaluation of important clinical factors to comprehend fully the epidemiological aspects of this condition.

AN EPIDEMIOLOGICAL STUDY OF VARICOCELE

Background: Varicocele, an abnormal dilatation and tortuosity of the pampiniform plexus of veins is found in about 15% of the general population with a marked left sided predominance. However this incidence rises to 35% in men with primary infertility and 70 to 80% in men with secondary infertility.&#x0D; Methods: Hospital based prospective study conducted on 100 cases reporting to General surgery department within the study duration and eligible as per inclusion criteria was included in study.&#x0D; Results: In our study out of Out of 100 patients maximum 42.00% patients were farmer followed by 22.00% patients were Coolies and Rickshaw Pullers, 17.00% patients were students, 10.00% were laborer and 9.00% were policemen.&#x0D; Conclusion: It conclude that Varicocele epidemiology remains incompletely understood. We need well‑designed, large‑scale studies that include evaluation of important clinical factors to comprehend fully the epidemiological aspects of this condition.

Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele.

The study summarizes the effectiveness of ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome (NCS)-associated varicocele. Cases of NCS-associated varicocele were recruited between December 2012 and December 2018. Prior to the operation, all patients were tested for the internal diameter and blood flow velocity of left renal vein, testicular volume, maximum venous diameter and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver by Color Doppler ultrasound. Moreover, the direction of left spermatic and inferior epigastric vein was marked. All patients underwent ligation of the internal spermatic veins and left spermatic-inferior epigastric vein anastomosis under microscopy. Color Doppler ultrasound, urinary and semen analysis (above age 18years old) were reviewed during the follow-up period. 53 patients (94.6%) underwent spermatic-inferior epigastric vein anastomosis with the mean operation time of 78.4 ± 14.2min. The hospital stay was 4-7days. Scrotal hydrocele, wound infection and testicular atrophy did not occur after operation. However, there were 5 cases of left varicocele recurrence and 2 cases of vascular anastomotic thrombosis. 51 cases had decrease in blood peak flow rate of left renal vein and improvement in nutcracker syndrome while scrotal bulge symptoms resolved in 26 cases. 10 cases had microscopic hematuria disappearance with symptom improvement in 2 cases. 19 cases of left testicular hypotrophy experience no further deterioration after surgery, of which 16 cases had catch-up testicular growth. Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis assisted is safe, easy and effective for treating nutcracker syndrome-associated varicocele.

Отдаленные результаты первого опыта лечения мужчины с синдромом Мея–Тюрнера и варикозной болезнью вен органов малого таза

Recurrent and bilateral varicocele represent two least studied aspects of the disease. There is no recommendation in current urological and andrological guidelines in various countries on the diagnosis and treatment of such patients. The first experience of successful surgical treatment of a patient with recurrent varicocele due to May-Thurner syndrome is presented in this paper. The patient had a severe form of the disease and admitted with the varicocele recurrence after 5 previous intervention with chronic pelvic pain syndrome, erectile dysfunction, chronic calculous prostatitis and varicose veins of the pelvic organs. The patient underwent balloon angioplasty and stenting of the left iliac vein on 28th March, 2017 in the City hospital named after E.O. Mukhin. There was almost complete resolution of pelvic pain in the immediate postoperative period (within 1 hour). One week after surgery the patient noted a recovery of erection without any therapy. Three months later, a 45% reduction in the maximum diameter of the prostatic veins was noted according to transrectal ultrasound (TRUS) as well as a lack of antegrade blood flow according to the color Doppler TRUS at rest and during Valsalva's test. There was no deterioration of symptoms during follow-up. Overall, the venous blood flow in prostate was decreased which accompanied by the reducing in pain syndrome and restoration of sexual function without medical therapy. The reduction of diameter of testicular and epididymal varicose veins was seen 6 months after surgery. The diameter of veins of pampiniform plexus in supine position at rest was less than 2 mm. There was no retrograde flow neither in supine, nor in stand position during Valsalva maneuver. Thus, X-ray endovascular angioplasty and stenting of the iliac veins in case of arterio-venous crossing at the lower level is a pathogenetically justified and highly effective treatment of varicocele and varicose veins of the pelvic organs in men.

Inter-observer agreement on varicoceles diagnosis among patients referred to Shiraz Namazi Hospital

Varicocele is the collection of dilated veins of pampiniform plexus which is the most common cause of infertility occurred in 35-40% of infertile men. Despite all the diagnostic tools exist for varicocele diagnosis; still, a physical examination is the first step. This study was done to determine the inter-observer agreement on varicoceles diagnosis. In this cross-sectional study, two expert examiners evaluated 93 men with infertility, scrotal pain, and enlarged scrotum for the presence of varicocele. The urologists examined patients independently in two separate rooms. The inter-observer agreement on varicocele grading analyzed by the Spearman Rho correlation coefficient. The grading of varicocele were similar in 34 (36.5%) and 59 (63.4%) cases in the left and right side, respectively with correlation coefficient of 0.65 (0.51-0.75) and 0.25 (0.04-0.43), respectively. It implies that inter-observer agreement was substantial for left varicocele assessment and moderate for right varicocele assessment. Physical exam is the essential diagnostic tool for varicocele. As long as the observers educated with the same standard method the disagreements reduced to the negligible extent.

Antegrade sclerotherapy in adolescent varicocele patients

In the 1970s, Tauber described the antegrade sclerotherapy technique to treat varicoceles, and reported a 10% recurrence rate. The present study aimed to evaluate paediatric success rates and the effect of modifications to the surgical technique. A prospective study was performed of all adolescent patients undergoing antegrade sclerotherapy surgery. Each patient had an idiopathic varicocele with spontaneous venous reflux on Doppler examination, and underwent cannulation of a pampiniform plexus vein via a scrotal incision under general anaesthetic. Aethoxysklerol® 3% (2ml/kg) maximum 3ml was injected into the pampiniform plexus vein under fluoroscopic monitoring. Success was assessed by clinical examination and Doppler ultrasound 3, 6 and 9 months after surgery. Data were presented as median (interquartile range). Patients were split into three groups: Group A - liquid sclerotherapy with Y connector; Group B - liquid sclerotherapy direct to cannula; and Group C - foam sclerotherapy direct to cannula. Fisher's exact test was used to compare the success rates in each group. A total of 91 patients underwent antegrade sclerotherapy. The median age was 14.8 years (range 13.7-15.5). Eleven persistent varicoceles occurred and were diagnosed by Doppler ultrasound. The success rate of surgery was 58% in Group A, 90% in Group B and 96% in Group C. Success was significantly higher in Group B and Group C compared with Group A. No testicular atrophy occurred; two wound infections, two haematomas and one hydrocele were recorded (Table). Introduction of antegrade sclerotherapy in the adolescent population resulted in a safe and cost-effective method for the management of adolescent varicocele. Several modifications to the technique have been introduced to achieve a high success rate (96%) with minimal complications.

AB30. Effects of varicocele on male infertility

Varicoceles are an abnormal dilation of the pampiniform plexus of veins within the scrotum. Varicoceles are highly prevalent and can result in a myriad of deleterious effects on male reproduction. Numerous therapeutic options are available for correcting varicoceles, including surgical varicocelectomy radiographic venous embolization. The current literature is reviewed in an effort to answer the questions that varicocelectomy is really beneficial in the treatment of male factor infertility. Based upon the analysis, conclusions can be drawn that varicocele may cause any variation of severity in spermiogram including azoospermia. The treatment of varicocele may significantly improve spermatogenesis and renew sperm production. Adequate treatment may spare the need for TESE as preparation for ICSI in >30% of azoospermic patients. Since achievement of pregnancy in IVF units is higher when spermatogenesis is better, the treatment of varicocele is an effective medical adjunct for IVF units prior to the treatment. In men with spermatogenic failure, freshly ejaculated sperm are easier to use, and fertilization ability in ICSI is higher with normal semen than with sperm retrieved by TESE. For bilateral clinical varicoceles, microsurgical repair is a favourable option for treating couples with male factor infertility.

Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Varicocele is an abnormal condition characterized by dilatation of the pampiniform plexus veins draining the testis and is present in 15 % of men. Varicoceles have an adverse effect on spermatogenesis and are the most common cause of male infertility. Approximately 35 % of infertile men and more than 70 % of men with secondary infertility were reported to have varicoceles. Although data on methods of varicocele repair are accumulating, there remains controversy regarding the indications and techniques for varicocele repair. In addition, the role of varicocele repair in this era of assisted reproductive technologies continues to be debated. In this study, we performed a comprehensive PubMed search in order to review the current status of varicocele repair for male infertility. We reviewed English-language studies published from 1992 through 2013. After reviewing the articles, we identified a recent meta-analysis of four randomized controlled trials, which found that varicocele repair for oligozoospermic men was associated with better pregnancy rates as compared with observation. Our review of prospective studies showed that all semen parameters, including sperm concentration, motility, and progressive motility, were significantly improved after varicocele repair. We also summarize the findings of recent studies reporting beneficial effects of varicocele repair, i.e., decreased oxidative stress and sperm DNA fragmentation after varicocele repair and superior cost effectiveness versus in vitro fertilization/intracytoplasmic sperm injection alone, which may be important in the era of assisted reproductive technologies. Varicocele repair is a widespread, well-established procedure that can improve semen parameters in men with infertility. The effect of such treatment on the pregnancy rate is unclear because evidence is limited due to difficulties in recruiting patients for studies. Among the repair techniques, microsurgical repair using a subinguinal approach is potentially the best practice, although this procedure requires training in microsurgery. All these topics require further research in studies with sufficient patient enrollment and follow-up.

Intravenous methylene blue venography during laparoscopic paediatric varicocelectomy

IntroductionOne of the challenges of varicocele surgery is to prevent hydrocele formation while still ensuring success. Methylene blue has been used to identify and preserve lymphatic vessels, and venography has been a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined both approaches during laparoscopic varicocelectomy and report their experience. MethodsA prospective study was performed of adolescents with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque™ was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as Plasmakinetic™ or Ligasure™. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6, and 9months post-surgery with clinical examination and Doppler ultrasound. Data are presented as median (interquartile range). ResultsTwenty-four patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 (14.6–15.7) years. The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 (100–126) minutes. ConclusionIntra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach prevents hydrocele formation but has a 12% recurrence rate, which appears to be higher than some techniques described in the literature.

English

Abstract Introduction Testicular vessels play a major role in thermoregulation of male reproductive organs, which is an essential aspect for their effective functioning. Testicular veins exhibit wide variations in their course, number and mode of termination. Case report A variation in the testicular vein was observed unilaterally in a 50year-old male cadaver during the course of a preclinical training program. Two testicular veins (medial and lateral) were present on the left side. Both medial and lateral testicular veins were found draining into the left renal vein at right angles. The lateral testicular vein displayed bifurcation close to its termination into the left renal vein. The right testicular vein followed usual course and drainage. The left kidney also exhibited a distinct intrarenal cleft. Conclusion The testicular vein variations become significant during ligation of the abnormal venous dilatations and collaterals, thereby reducing the chances of recurrence of varicocele which is a specific pathological condition causing male infertility. The present case report attempts to provide an insight into the developmental aspects and surgical importance of this unusual variation. Introduction Testicular veins are the channels arising from the pampiniform plexus of veins which is formed at the upper pole of the testis by the smaller veins draining the testis. It then traverses through the spermatic cord and at the superficial inguinal ring, four veins are formed which course through the inguinal canal and at the deep inguinal ring, these coalesce and form two or three veins. In the lumbar region, these veins combine and form a single testicular vein on the respective sides. These testicular veins ascend along the posterior abdominal wall anterior to the psoas major muscle, ureter and behind peritoneum. The right testicular vein drains into the inferior vena cava (IVC) at an acute angle, whereas the left testicular vein drains into the left renal vein at right angles1. The anatomy of testicular veins has been associated with wide variations. These variations become significant during clinical cases of varicoceles and retroperitoneal surgeries. Varicocele affecting approximately 15% of the male population is the abnormal dilatation of veins of pampiniform plexus causing testicular atrophy and male infertility2,3.

Histopathological and immunohistochemical study of the wall of spermatic veins and its potential role in the development of varicocele testis

IntroductionVaricocele is defined as a pathological alteration in the venous circulation of the testis which appears almost exclusively on the left side.The aim of current work was to compare the normal structure of the wall of the veins of the pampiniform plexus and also to highlight the occurrence of any structural alterations in these veins in cases of primary varicocele through a combined histopathologic and immunohistochemical study. MethodsHistopathological examination and immunohistochemical studies using monoclonal antibodies against CD31 (a marker for endothelial cells) and neurofilament-200 (NF-200) (nerve fiber marker) were performed on spermatic vein fragments of 30 varicocele patients and 30 normal spermatic veins obtained from patients undergoing inguinal herniectomy. ResultsNormal spermatic veins showed an inner circular smooth muscle (SM) layer in the tunica media, and an outer longitudinal SM layer in the tunica adventitia. Grade I varicocele cases, showed an increase in the connective tissue of the adventitia and of the tunica media, which increased proportional to the degree of varicocele. The outer longitudinal smooth muscle layer of the large spermatic veins was significantly degraded in the presence of varicocele grades I and II, and did not even exist in varicocele grade III. Immunostaining for CD31 and NF-200 revealed that vasa vasorum and nerve fibers were decreased in the wall of large spermatic veins in patients with grades I and II varicocele, and were minimal to absent in patients with grade III varicocele. ConclusionThe wall of pampiniform plexus veins is a complex structure of smooth muscle organization, inner circular and outer longitudinal fibers which is important for providing an effective blood transport through the pampiniform plexus. This mechanism is obviously damaged in varicocele patients.