Spermatic Vein Research Articles

Clinical and therapeutic aspects of laparoscopic varicocelectomy: a cross-sectional study in Douala, Cameroon

INTRODUCTION: Varicocele is an abnormal tortuosity of the pampiniform venous plexus and internal spermatic veins that drains the testicle. It is a well-recognized cause of decrease in testicular function, affecting approximately 15-20% of all males and 40% of infertile men globally. Principles of varicocele management consist of interrupting internal spermatic venous reflux while preserving the internal spermatic artery and the vas deferens. Treatment can be obtained through spermatic venous embolization or surgical, which could be performed by open or laparoscopic approach. The purpose of this study was to evaluate the clinical and therapeutic aspects of laparoscopic varicocelectomy in the city of Douala. METHODS: we report a descriptive cross-sectional study including a retrospective and prospective component. We reviewed files of patients who underwent laparoscopic varicocelectomy from January 2015 to May 2021. Clinical and diagnostic components of varicocele, indications and therapeutic outcomes were analyzed. RESULTS: we total of 71 patients were included in our study. The average age of patients was 34.34 years. Scrotal pain was the most represented clinical sign (46.48%). Varicocele was found on the left in 77.46% of patients. Scrotal pain represented 49.3% of the operative indications, and 81.70% of the patients had their spermatic arteries preserved. Vascular injury was the most common intraoperative complication with 5.63%, while peri-incisional pain (7.04%) was the most common post-operative complication. CONCLUSION: laparoscopic varicocelectomy is safe and beneficial with favorable outcome. However, there is limited availability of this approach in our setting, mainly due to lack of technical facilities and practitioners able to popularize it.

Isolated Giant Mesenteric Vein and Anomalous Inferior Mesenteric Vein Insertion in the Presence of Cirrhosis – A Cadaveric Case Report

The inferior mesenteric vein is one of the tributaries of the portal vein which receives blood from the large intestine, sigmoid colon and the rectum. It usually connects with the splenic vein before draining into the portal vein. It may however show variations such as joining the superior mesenteric vein directly or to the confluence of the superior mesenteric vein and splenic vein. Varices of the inferior mesenteric vein can be seen in the presence of portal hypertension due to various reasons and this can be isolated or in association with other portosystemic collaterals. We report a case of a giant isolated inferior mesenteric vein with an anomalous insertion. The inferior mesenteric vein was seen to be connected to the superior mesenteric vein before draining into the portal vein. Further, on the distal end it was seen to be connected to the left renal vein, which in turn had dilated and enlarged. The left testicular vein was observed draining in to the inferior mesenteric vein but was not enlarged. The superior mesenteric vein, splenic vein and portal vein were not enlarged or varicosed even though the liver showed features of cirrhosis with no obvious signs of splenic enlargement. This report contributes to enhance the knowledge on a rare anatomical connection between portal system and the systemic circulation and will be important to surgeons operating in this area.

10-year experience of Paediatric varicocele embolization in a tertiary centre with long-term follow-up

Paediatric varicocele embolization has many benefits over surgical ligation, but lacks published long-term data. We investigated technical and clinical outcomes in this under reported patient group. To evaluate technical success, complications and recurrence rates following varicocele embolization in paediatric patients. A single-centre retrospective review of procedural data and electronic notes of consecutive patients referred for varicocele embolization over a 10-year period was performed (February 2010-March 2020). The primary outcomes were technical success and clinical efficacy (lack of symptom recurrence). Secondary outcomes included complications, testicular vein size reduction and procedural parameters including radiation exposure. Chi-square analysis was used to identify predictors of clinical success. Follow-up involved outpatient clinical assessment and telephone interview. 40 patients (median age 15) were referred for left-sided symptomatic varicocele. Technical embolization success was achieved in 36/40 patients (90%), with 4 procedures abandoned (inaccessible vein). Embolization technique was platinum-based coils±sclerosant. There were no immediate or long-term procedural complications. 32/36 patients completed short term follow-up at a median interval of 2.8 months. 30/32 (93.78%) experienced early clinical success. We found a significant reduction in peritesticular vein size following embolization (pre-3.70 vs post-2.56mm, p=0.00017) and a significant relationship between varicocele grade and early clinical success (χ2=4.2, p=0.04), but not pre-treatment peritesticular vein size (χ2=0.02, p=0.88). 33/36 patients completed long-term follow-up (median 4.2 years, range 0.36-9.9 years) producing a late clinical success rate of 93.9% (31/33). No post procedural complications including hydroceles were identified. This study demonstrates technical success, matching rates described in adult patients which is reassuring and in support of embolization in the younger patient cohort. More importantly, the overall clinical success rate is comparable with previous embolization studies. Reassuringly, all symptom recurrences occurred early in follow-up, and there is a cogent argument for a single follow-up appointment at this juncture. Our long-term average follow-up duration, primarily gained via telephone interview, exceeds other studies. Although our study has the longest follow-up for varicocele embolization in children, it is limited by a few patients being lost to early and long-term follow-up. This is a recognised issue faced by studies attempting to follow-up benign conditions with a high clinical success rate. Paediatric varicocele embolization is a successful alternative to surgical ligation, with no complications and good clinical outcomes over a long-term follow-up.

Renal cell carcinoma with tumor thrombus growing against the direction of venous return: an indicator of complicated surgery and poor prognosis

PurposeTo explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis.MethodsWe retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan–Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS).ResultsCompared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P = 0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P = 0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P < 0.001); higher preoperative serum creatinine value (110.0 μmol/L vs. 91.0 μmol/L, P = 0.015), a higher proportion of tumor thrombus combined with bland thrombus (non-tumor thrombus) (57.1% vs. 19.8%, P < 0.001). In terms of surgical complexity, patients with GADVR tumor thrombus had a longer median operation time (379 min vs. 308 min, P = 0.038), more median surgical blood loss (1400 mL vs. 600 mL, P = 0.018), and more postoperative complications (52.4% vs. 30.7%, P = 0.045). Multivariate Cox regression analysis showed that GADVR tumor thrombus, symptoms, postoperative serum creatinine, distant metastasis, sarcomatoid feature, pathological type, lymph node dissection were independent risk factors for PFS. Patients with GADVR tumor thrombus’s median survival time was 14.0 months, while patients with non-GADVR tumor thrombus were 32.0 months (P = 0.016). GADVR tumor thrombus is an independent risk factor for PFS in patients with RCC and VTT.ConclusionGADVR tumor thrombus is a characteristic feature of tumor thrombus, with an incidence of 9.9%. It has a higher proportion of open surgery and higher surgical complexity, which is an independent risk factor for PFS.

Thrombosis of Right Spermatic Vein: A Case Report

Spermatic vein thrombosis is a rare event that mostly affects the left vein thrombosis, but, in our report, it had developed on the right one that requires a meticulous physical examination for diagnosis. The purpose of this case report is to introduce an adult patient with right spermatic vein thrombosis in a 30-year-old man admitted to the operating room for hernia surgery. Spermatic vein thrombosis is an unexpected finding in the differential diagnosis of acute testicular pain.

Characterization of varicocele-induced animal models: Potential role of inflammasome complex in the varicocele pathophysiology

Varicocele mechanisms and its impact in testicular dysfunction has been studied in order to understand the pathophysiology involved in this disease. However, study designs using testicular tissues from varicocele patients are restricted due to ethical limitations. Therefore, the use of animal models, mainly rats, that mimics varicocele and its effects is an option to develop new approaches. The surgical technique, that induces the varicocele in rats, is based on the partial obstruction of the left renal vein, leading to a dilation in the left spermatic vein and consequently to the pampiniform plexus, resulting in varicocele-induced condition. Thus, the study of the cellular and molecular mechanisms involved in varicocele development can be addressed in depth. Besides the animal model goal to uncover the exact varicocele pathophysiology, varicocele induced models are the best options to develop new non-surgical and less invasive therapies. Various animal model studies designed and investigated antioxidant and anti-inflammatory agents to face varicocele conditions. Minding this fact, we tried to discuss a newly uncovered complex in varicocele condition, known as inflammasome complex. Taking into consideration the possible inflammatory state present in varicocele, the inflammasome complex has been proposed to be involved in the pathophysiology of this disease.

Assessment of seminal cystatin C levels in infertile men with varicocele: A preliminary study

Varicocele has been raised as a contributor to male infertility supported by the improvement of sperm parameters after varicocelectomy. Cystatin C (Cys C) has been linked to several cellular changes that are common in male infertility cases associated with varicocele such as apoptosis and autophagy. This preliminary study aimed to assess the seminal levels of Cys C in infertile oligoasthenoteratozoospermic (OAT) men associated with varicocele that have been shown to have spermatic vein vasodilation and active death pathway. Overall, 60 men were investigated being divided into two equivalent groups-infertile OAT men with varicocele who underwent varicocelectomy and healthy fertile men as a control group. These men were subjected to history taking, clinical examination, semen analysis and assessment of seminal Cys C pre and 6months post-varicocelectomy. The results showed a significant increase of seminal Cys C in infertile OAT men with varicocele than the fertile control (55.57±25.6ng/ml versus 10.78±1.88ng/ml, p=.001). Seminal Cys C was a significantly decreased post-operative than its pre-operative level (34.69±14.02 versus 55.57±25.6ng/ml, p=.01). These results show a potential role of Cys C in varicocele-induced infertility.

Impact of testicular delivery and vasal vein ligation on clinical outcomes in men undergoing microsurgical varicocelectomy.

To assess the impact of microsurgical varicocelectomy technique on clinical outcomes. Men diagnosed with varicocele between 2017 and 2020 were reviewed. We included men who underwent microsurgical varicocelectomy by two high-volume surgeons who differed in surgical technique: Method (1) testicular delivery with gubernacular vein ligation, and ligation of vasal veins > 2.5mm; Method (2) no delivery and ligation of dilated vasal veins in cases of recurrence. Post-operative changes for semen parameters, DNA fragmentation, and serum testosterone were evaluated for each technique and compared. 313 patients were included; 162 with Method 1 and 151 with Method 2. The cohorts were of similar age (median 35years, interquartile range (IQR) 28-43; 34, IQR 28-39, respectively), and BMI (25kg/m2, IQR 23-27; 25, IQR 23-28, respectively). For Method 1, 84 (51.9%) had bilateral surgery, and 78 (48.1%) had unilateral surgery. For Method 2, 63 (41.7%) had bilateral surgery, and 88 (58.3%) unilateral surgery. In patients with sperm concentration > 5M/mL, both techniques resulted in an improvement (p < 0.01), but there was no difference between the methods (p = 0.18). Both methods were associated with an improvement in total motile count (p < 0.05) and the amount of DNA fragmentation (p < 0.05), although no differences were apparent between the techniques (p = 0.09, p = 0.81, respectively). Finally, testosterone levels improved with Method 1, but the post-operative difference was not different than Method 2 (p = 0.06). Delivery of the testis and ligation of dilated vasal veins compared to not performing those steps do not impact semen parameters, but are associated with improvement in testosterone levels.

The role of antioxidants in the treatment of infertile men with varicocele

Varicocele is a common disease that occurs in 35–40% of men with primary infertility and in 80% of men with secondary infertility Disturbance of microcirculation in the testicles, which occurs during varicocele, lead to ischemia and hypoxia of the testicles, which provoke degenerative changes in all testicular cell populations. Retrograde blood flow from the testicular vein and the external spermatic vein into pampiniform venous plexus leads to an increase of hydrostatic pressure in the testicular vascular system and rise of temperature, and it also contributes to the development of sterile inflammation. Oxidative stress, nitrosative stress, and hypoxia are generally recognized elements of the pathogenesis of infertility associated with varicocele. It is known that when the supraphysiological level of reactive oxygen species in the ejaculate is reached, their concentration disrupts the structure and function of spermatozoa. Nitric oxide (NO) is involved in the regulation of body temperature, NO-dependent mechanisms may contribute to the increased scrotal temperature during varicocele. The physiological concentration of NO pro duced by testicular macrophages stimulates steroidogenesis in Leydig cells. However, in the presence of certain reactive oxygen species, NO can transform into peroxynitrite and other strong cytotoxic metabolites, which lead to dysregulation of testosterone synthesis involved in spermatogenesis. Also, manifestations of varicocele among infertile men have decreased expression levels of the testis-specific heat-shock protein, HSPA2, and abnormal methylation of sperm DNA. Therefore, the use of combined anti oxidant supplements as part of adjuvant therapy after surgical treatment or as an independent application in some clinical cases appears to be an adequate strategy to optimize fertility in patients with varicocele. In this review, we evaluated the importance of various antioxidants, such as vitamin E, folic acid, carnitine, inositol, arginine, acetylcysteine, zinc, selenium in spermatogenesis and their effect on reproductive function during varicocele.

991 Managing Recurrent Bleeding from Varicose Veins of The Scrotum: A Case Report

Abstract Introduction Spontaneous recurrent bleeding scrotal varicosity is a rare clinical presentation. The management is undefined and is usually anecdotal from previous case reports. The anatomy and pathophysiology of these presentations are usually complex hence resulting in atypical and challenging management options. To highlight this, we present a case of a patient with recurrent scrotal bleeding secondary to scrotal varicosities. Care report A 39-year-old gentleman with heart failure, 4 previous episodes of transient ischemic attacks and atrial fibrillation who was anticoagulated, presented with recurrent left sided scrotal bleeding from dilated superficial scrotal veins. In total, he had 11 presentations over 4 years requiring blood transfusion on 4 occasions. On one occasion the patient required 7 units of packed red blood cells transfused. He had a background of heart failure with hepatic congestion and ascites which failed medical management. Compression, adrenaline and tranexamic acid-soaked gauze, as well as over-sewing feeder vessels offered only short-term relief. His heart failure was difficult to optimise and stopping anticoagulation was not possible, even for a short period of time, due to the high risk of stroke in this patient. Venography revealed a prominent left testicular vein that extensively fed the scrotal veins with bilateral varicoceles. After discussion with the Vascular team, percutaneous coil embolization of the left testicular vein was performed with good results. He has had no significant scrotal bleeding since. Conclusions Managing bleeding scrotal varicose veins can be challenging. A multidisciplinary approach may be the most appropriate in managing these patients.

Outcome of Extended Varicocelectomy in Case of High Grade Varicocele

Abstract Background Varicocele is defined as abnormal dilation and tourtousity of the internal spermatic veins within the pampiniform plexus. It is common among adolescents and may contribute significantly to the risk of subfertility in adulthood. Objective To evaluate the outcome of extended varicocelectomy in case of high grade varicocele. Patients and methods In all, 30 varicocele cases including 12 left sided and 18 bilateral, comprising 48 spermatic cord units with clinically palpable varicocele and affected semen analysis underwent extended varicocele ligation. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, scrotal doppler ultrasonography, as well as semen analysis to detect varicocele recurrence, hydrocele formation and early changes in semen parameters. The postoperative evaluation period was 3 months. Results No varicocele recurrences were clinically detectable after our surgical approach, No hydrocele formation, and There was improvement in the parameters of semen analysis in the entire patients presented with infertility associated with varicocele as regard improvement in the count, motility, and decrease in the abnormal forms 3 months after varicocelectomy. Conclusion Extended varicocele ligation with delivery of the testis achieve good surgical outcome with minimal varicocele recurrence and hydrocele formation, and offer beneficial effect on semen parameters.

Case - Laparoscopic excision of the right testicular vein post-varicocele embolization and coil erosion.

Not required

X-ray endovascular methods for the treatment of veno-occlusive erectile dysfunction

The results of surgical treatment of 59 patients with veno-occlusive erectile dysfunction and follow-up of 8 years are presented. The age of patients is 18-48 years old (average age is 29.3 ± 7.6). Five of them had hemodynamic and clinical signs of arteriovenous erectile dysfunction in the stage of subcompensation, 16 patients underwent simultaneous treatment in the form of sclerotherapy of testicular veins in connection with the secretory type of male infertility, 5 underwent simultaneous surgical treatment to eliminate veno-occlusive and arterial insufficiency of the cavernous bodies of the penis by stenting of the internal iliac or pudendal arteries, 2 patients underwent delayed stenting of the iliac veins due to May-Turner syndrome, the remaining patients underwent surgical treatment aimed at eliminating venous erectile dysfunction. The diagnosis was established on the basis of a clinical and urological examination, including physical examination and questioning according to the IIEF-5 (International Index of Erectile Function), ultrasound Doppler examination of the cavernous bodies of the penis with intracavernous pharmacotest, dynamic computer pharmacocavernosography with 3D reconstruction, with veno-occlusive arteries with suspected arteries, or computer tomography arterial insufficiency of the cavernous bodies of the penis. All types of endovascular and hybrid operations on the venous collectors of the penis were analyzed. Priority surgical techniques for the treatment of pathological venous drainage have been identified, which are 75 % effective in the long-term postoperative period. Based on the presented experience of the authors and analysis of foreign literature, the expediency of revising the European and Russian recommendations for venous surgery of the penis towards the priority use at the first stage of minimally invasive X-ray surgical treatment in a category of young patients has been proved.

Production of 11-Oxygenated Androgens by Testicular Adrenal Rest Tumors.

ContextTesticular adrenal rest tumors (TART) are a common complication in males with classic 21-hydroxylase deficiency (21OHD). TART are likely to contribute to the androgen excess in 21OHD patients, but a direct quantification of steroidogenesis from these tumors has not been yet done.ObjectiveWe aimed to define the production of 11-oxygenated 19-carbon (11oxC19) steroids by TART.MethodsUsing liquid chromatography-tandem mass spectrometry, steroids were measured in left (n = 7) and right (n = 4) spermatic vein and simultaneously drawn peripheral blood (n = 7) samples from 7 men with 21OHD and TART. For comparison, we also measured the peripheral steroid concentrations in 5 adrenalectomized patients and 12 age- and BMI-matched controls. Additionally, steroids were quantified in TART cell– and adrenal cell–conditioned medium, with and without adrenocorticotropic hormone (ACTH) stimulation.ResultsCompared with peripheral blood from 21OHD patients with TART, the spermatic vein samples displayed the highest gradient for 11β-hydroxytestosterone (11OHT; 96-fold) of the 11oxC19 steroids, followed by 11-ketotestosterone (47-fold) and 11β-hydroxyandrostenedione (11OHA4; 29-fold), suggesting production of these steroids in TART. TART cells produced higher levels of testosterone and lower levels of A4 and 11OHA4 after ACTH stimulation compared with adrenal cells, indicating ACTH-induced production of testosterone in TART.ConclusionIn patients with 21OHD, TART produce 11oxC19 steroids, but in different proportions than the adrenals. The very high ratio of 11OHT in spermatic vs peripheral vein blood suggests the 11-hydroxylation of testosterone by TART, and the in vitro results indicate that this metabolism is ACTH-sensitive.

Expression of Hypoxia-Inducible Factor1-α in Varicocele Disease: a Comprehensive Systematic Review.

Hypoxia has been suggested as an important pathophysiological feature in varicocele disease. On the other hand, the expression of hypoxia-inducible factor 1-alpha (HIF1-α) is associated with the incidence of hypoxia. In this study, we investigated the expression of HIF1-α in varicocele disease through a comprehensive systematic review. We searched PubMed, Scopus, Web of Science, and Embase databases to identify the related studies published up to February 2021. Human studies have demonstrated an increase in the HIF-1α protein expression in the internal spermatic vein (ISV) of the varicocele testicle. HIF-1α mRNA expression in the seminal plasma was significantly higher in infertile varicocele patient compared with fertile ones. Similarly, most animal studies demonstrated a significant increase in HIF-1α gene and protein expression in varicocele testicular tissue compared with control groups. The studies illustrated that hypoxia followed by increased expression of hypoxia-inducible factor 1-alpha (HIF1-α) mRNA and protein occurs in varicocele disease. Expression of HIF-1α regulates the expression of many genes, including VEGF, p53, GLUT, Bax, and Caspase-3, that could be involved in many of the varicocele pathophysiological effects such as DNA fragmentation and apoptosis of sperm cells. Further studies with a large number of patients are necessary and can provide more definitive evidence.

Management of adolescent varicocele

Varicocele is defined as an abnormal dilation and tortuosity of the internal spermatic veins found within the pampiniform plexus. It is a common finding in adolescents and adult men alike, however its diagnosis in the adolescent population poses different dilemmas in regard to indications for treatment than in adults. Failed Paternity is a clear-cut indication for repair in adult men attempting to father children. In adolescents, the physicians, family and patients must consider potential for future fertility problems which may or may not actually become of concern. Assessing the degree of negative effect of the varicocele on an adolescent's testicular health can also be difficult as teenagers typically are not asked to provide semen for analysis and thus surrogate markers for testicular health such as testicular size differentials must be used. Treatment options for the adolescent varicocele are similar to options in adult populations. While risks and benefits of various techniques can be considered, the gold standard for varicocele repair in adolescents has not been clearly defined.We aim to discuss diagnosis of varicocele, considerations for initiating treatment of varicocele in the adolescent, and techniques for management.

A Rare Case of Anomalous Origin of Bilateral Testicular Arteries

An extensive knowledge of the origin and course of testicular arteries (TAs) is indispensable during various surgical procedures such as renal transplant, intra-abdominal surgeries, and even in orthopedic surgeries such as spine surgery. With the advent of new intra-abdominal therapeutic and diagnostic techniques, the anatomy of TAs has assumed much more significance. Although the variations of the testicular vein are well documented, the variations of the TA are not so frequent in incidence. We report a rare case of bilateral aberrant origin of the TA from polar renal arteries. Though anomalies of the polar arteries supplying the kidney are common, bilateral origin of TAs from them is a rare presentation. We also discuss its developmental basis. Such anomalies if left unnoticed will lead to serious intraoperative complications during procedures on retroperitoneal organs. Any damage to the TAs will compromise the function of the gonads.

Contribution of pre-varicocelectomy color Doppler ultrasonography finding to surgery and its correlation with semen parameters.

This study aimed to determine the contribution of color Doppler ultrasonography (CDUS) performed before varicocelectomy to the success of surgical treatment and to evaluate the correlation between CDUS findings and semen parameters. A total of 84 patients diagnosed with grade 3 left varicocele in our clinic between 2016 and 2018 were evaluated. The patients in whom the decision for varicocelectomy was based on only physical examination (PE) findings and abnormal semen analysis (SA) were defined as Group 1, while the patients undergoing varicocelectomy based on PE, CDUS and SA findings were defined as Group 2. The patients diagnosed with varicocele based on PE and CDUS findings who were included in a followup protocol due to normal semen parameters were defined as Group 3. In Group 1, there was a total of 28 patients and the mean number of ligated internal spermatic veins was 4.53 (range, 2-10). In Group 2, there was a total of 30 patients and the number of ligated internal spermatic veins was 3.76 (range, 1-8). No statistically significant difference was found between Group 1 and 2 in terms of the number of internal spermatic veins ligated during varicocelectomy. No statistically significant correlation was found between semen parameters and the number of veins ligated during varicocelectomy in Group 1 and 2 and between semen parameters and CDUS findings group 2 and 3. In patients with primary grade 3 varicocele, diagnosed by physical examination there is no need for additional imaging in primary cases.

Tek testise sahip genç hastada akut testiküler ven trombozu: nadir bir ürolojik acil

Acute scrotal pain due to testicular vein thrombosis is a rare condition. Thrombosis is defined as clot formation within the blood vessels and as a result, it interrupts the blood supply of the peripheral organs. In routine urology practice, the incidence of thromboembolic diseases is &lt;1%, and it is mostly encountered in patients at the postoperative period. Nevertheless, testicular vein thrombosis should also be remembered in the differential diagnosis of patients admitted to the emergency department due to acute scrotum. In general, conservative treatment is the first choice in treatment management, but surgical intervention may also be required in some cases. Since the available data on this subject are based on the information obtained from case reports, a standard treatment approach should be developed by examining the current treatment methods. We aim to present the case report of testicular vein thrombosis in the light of the literature, which is one of the rarely seen emergencies of urology. Keywords: acute pain; color doppler ultrasonography; venous thrombosis; testicular diseases

Evaluation of oxidative stress in seminal plasma of adolescents with varicocele.

SummaryVaricocele, defined by a dilation of efferent testicular veins, is the most commonly identifiable, surgically correctable lesion associated with male-factor infertility, starts at puberty and causes a progressive decline in fertility potential. The pathophysiology of infertility caused by this disease is still poorly understood, but it is suggested that the main mechanism is oxidative stress. Therefore, the aim of this study was to verify if the varicocele is associated with changes in enzymatic antioxidant mechanisms and seminal plasma lipid peroxidation levels in adolescents. We recruited 90 adolescents that were divided into control (C; n = 27); varicocele and normal semen (VNS; n =46); varicocele and altered semen (VAS; n =17). Seminal and serum levels of lipid peroxidation were quantified by thiobarbituric acid reactive substances (TBARS). Seminal plasma antioxidant profile was evaluated by the activities of catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD). The VAS group had increased lipid peroxidation levels when compared to the other groups. The levels of serum lipid peroxidation and activities of the enzymes SOD and GPx did not differ between groups. CAT was undetectable by the method used. In conclusion, in adolescents with varicocele and altered semen analysis, there is an increase in seminal lipid peroxidation levels compared to adolescents with varicocele and without seminal change and adolescents without evident varicocele. However, the observed oxidative stress is not caused by a decrease in superoxide dismutase and glutathione peroxidase activities, which did not differ between adolescents with and without evident varicocele.Lay summaryVaricocele, defined by a dilation of efferent testicular veins, is the most commonly identifiable, surgically correctable lesion associated with male-factor infertility, starts at puberty and causes a progressive decline in fertile potential. There is still much that is not understood regarding how exactly it affects semen quality, but most studies agree that oxidative stress, which is defined as excessive amounts of free radicals in relation to antioxidant defense, is an important mechanism. In this study, we aimed to verify if the varicocele is associated with changes in antioxidant defense and semen oxidation in 90 adolescents with and without varicocele. In adolescents with varicocele and abnormal semen, there is an increase in semen oxidation compared to controls or to the group with varicocele and normal semen quality. Our results can help to understand how varicocele leads to infertility in adolescents, identifying changes in oxidative activity in semen, since the onset of varicocele and before damage to sperm production can be detected.