A microsurgical venous bypass between the internal spermatic vein (ISV) and inferior epigastric vein was proposed five decades ago for varicocele treatment. Limitations of this technique include large incision, transverse fascia transection, delayed recovery, and mandatory venography to rule out external iliac vein compression (present in ~10% of patients). To address the limitations, a modified microsurgical varicocelectomy with internal spermatic to superficial epigastric vein (SEV) bypass was developed and evaluated in this study. The ISV-SEV bypass was performed in all adolescents (≤18 years) undergoing microsurgical varicocelectomy between May 2021 and October 2023 for left testicular hypotrophy, pain, or oligospermia. The first 100 consecutive cases were analyzed. Outcomes included length of hospital stay, complications, recovery time, postoperative Doppler parameters (testicular volume, reflux, anastomosis patency), recurrence, and improvement in testicular volume and semen characteristics. Minimum follow-up was 12 months. Mean patient age was 15.5±1.15 years. Main indications included hypotrophy (72%) and oligospermia (24%). Median operative time was 55 minutes (range 45-90). All patients were discharged within 24 hours. Median return to school and sports was 4.5 and 14 days, respectively. Testicular volume improved in 54/72 patients with hypotrophy. All oligospermic patients showed significant sperm count improvement (mean 15.2 to 88.2 million; P < 0.0001). Rates of atrophy, hydrocele, hematoma, and recurrence were 0%, 0%, 2%, and 1%, respectively. Residual Doppler reflux or persistent varices were noted in 11 patients, but without clinical relevance. Microsurgical varicocelectomy with ISV-SEV bypass appears to be a safe and feasible technique in adolescent patients, with encouraging short-term outcomes regarding testicular volume recovery and semen parameters. Low complication and recurrence rates are promising but further studies are needed to assess the benefit over standard techniques.

Low-dose-rate (LDR) brachytherapy with iodine 125 (125I) seeds is an effective treatment of localized prostate cancer, delivering targeted doses to the prostate while minimizing radiation exposure to adjacent tissues. 125I seeds implanted under transrectal US guidance provide tailored radiation distribution through loose or stranded configurations. Loose seeds allow flexible placement but carry a higher migration risk than stranded seeds. Optimal placement strategies involve targeting the peripheral zone near the prostate capsule to achieve adequate dose coverage for potential extracapsular extensions, with careful consideration to minimize toxicity to adjacent organs. Seed migration, primarily to the lungs, typically occurs through venous pathways due to the extensive periprostatic venous plexus. Less common migration sites include the heart, vertebral venous plexus, kidneys, liver, and testicular veins. Migration mechanisms involve retrograde venous flow and, in rare cases, arterial pathways through pulmonary arteriovenous malformations or intracardiac shunts. These seed migrations are typically incidental findings at imaging and rarely necessitate intervention because of the gradual radioactive decay of the seeds. Hydrogel spacers composed of polyethylene glycol are increasingly used during brachytherapy to reduce rectal toxicity by creating a separation between the prostate and rectum. Although these spacers are generally effective, complications such as asymmetric distribution, intraprostatic or intrarectal injection, and fistula formation can compromise radiation safety and efficacy. These complications can be identified at postprocedural imaging. Accurate imaging assessment is crucial for evaluating seed placement, detecting seed migration, and identifying complications related to hydrogel spacers, ultimately contributing to improved patient outcomes in prostate cancer treated with LDR brachytherapy. ©RSNA, 2025 Supplemental material is available for this article.

BackgroundVaricocele is the most prevalent condition in andrology. Current microscopic surgical techniques have demonstrated precise efficacy and are associated with numerous advantages. However, anesthesia protocols vary considerably across institutions, and achieving rapid recovery has become a major focus of research. Precision nerve block anesthesia represents a growing trend in the evolution of anesthetic techniques for varicocele surgery. The application of ultrasound (US)-guided ilioinguinal and iliohypogastric nerve blocks during low ligation of the spermatic vein, along with innovative anesthetic strategies, facilitates the performance of this procedure as ambulatory surgery—marking a novel advancement in the field. This paper aimed to evaluate the safety, convenience and efficacy of US-guided ilioinguinal-iliohypogastric nerve block (ILNB) in performing low ligation of the spermatic vein, and the novel anesthetic approach for low ligation of the spermatic vein as an ambulatory surgery was introduced.MethodsSixty-nine patients diagnosed with varicocele were enrolled in this study from March 2021 to August 2021, and all patients underwent low ligation of the spermatic vein. The patients were randomly divided into the conventional anesthesia group (CA: spinal anesthesia) or ILNB group. The ILNB group underwent real-time US guidance to examine the area around the ilioinguinal nerve (deep iliac circumflex artery) and the transverse abdominal muscle plane. When the effects of anesthesia were insufficient, sufentanil was administered intravenously as a supplementary anaesthesia. All surgeries were performed under a microscope by the same surgical group. The demographic characteristics, visual analogue scale (VAS) scores, recovery speed (duration until discharge postoperative period), postoperative adverse events, and medical costs in each group were recorded.ResultsTwenty-one patients received conventional anesthesia, while Forty-eight patients received the novel anesthesia method. There was no significant difference in demographic characteristics between the two groups. All patients achieved full recovery, and no postoperative adverse events, including bleeding, haematoma, or surgical site infection, were observed in any of the groups. Compared with those in the CA group, patients in the ILNB group had comparable postsurgical VAS scores, and the hospital expenses were lower.ConclusionsPatients in the ILNB group under US guidance were successfully anesthetized according to the requirements for undergoing microscopic low ligation during varicocele surgery. This novel method was proven to be both safe and effective and merits widespread application. US-guided ILNB for low ligation of the spermatic vein was considered “ambulatory surgery”. Compared with previous “ambulatory surgeries” under spinal anesthesia, the length of hospital stay was shorter for patients undergoing low ligation of the spermatic vein under ILNB: it was also safe and reliable and more precise, and the cost was lower. In addition to the advantages of significantly lower medical costs, this approach can shorten the hospitalization duration and save medical resources.

BackgroundVaricocele (VC) is a leading cause of male infertility. Insufficient growth and development of the cremaster muscle may contribute to VC, but the underlying mechanism remains unclear. Cremaster muscle dysfunction may impair venous valve support, contributing to VC. The cremaster relies on satellite cells (SCs) for postnatal growth and damage repair. This study aimed to explore the mechanism of the cremaster muscle in the process of VC.MethodsTen male Sprague-Dawley (SD) rats were divided into two groups: the VC model group (5 rats) and the sham-control group (5 rats). After four weeks of observation, the cremaster muscles were collected. The diameters of the left and right spermatic veins were measured, and the left testis was isolated for morphological examination via H&E staining. SCs isolated from the left cremaster muscle were analyzed using multiple methods, including qPCR and Western blot. Data were analyzed using SPSS v.22.0.ResultsCompared to the control group, the model group showed decreased TFRC mRNA stability, decreased mitochondrial membrane potential, and decreased GSH and GSSG contents, as well as increased m6A modification levels and increased ROS, MDA, and Fe2+ contents. In addition, the model group also showed downregulation of transferrin receptor (TFRC, a key iron uptake protein involved in ferroptosis) expression and upregulated m6A methyltransferase and recognition proteins. Multiple biochemical test results indicated increased ferroptosis, characterized by changes such as decreased mitochondrial membrane potential and GSH and increased ROS, MDA, and Fe2+.ConclusionThis study suggests that SCs in the cremaster muscle is associated with impaired cremaster muscle repair and VC pathogenesis through m6A modification of TFRC mRNA. Our findings offer fresh insights into the role of cremaster SCs in VC and provide a foundation for future research on the potential therapeutic target of VC.Strengths and limitations of this studyThis study is the first to investigate the pathogenesis of varicocele from the perspective of the cremaster muscle, and some clues have been discovered from it. The causal relationship between m6A-TFRC axis and ferroptosis requires further validation using functional rescue experiments (e.g., METTL3 knockdown or ferroptosis inhibitors). The small sample size may limit statistical power; future studies with larger cohorts are warranted.

Paradigm shift and long-term results in the diagnosis and treatment of pelvic venous disorder

What 'knot' to do whilst castrating donkeys. A retrospective comparison of ligation method on spermatic cord haemorrhage in 261 donkeys castrated by vet students in rural Malawi using transfixing and modified millers' ligatures.

The impact of non-incarcerated indirect inguinal hernia on testicular volume, spermatic veins, and serum inhibin B in children

Introduction Varicocele, characterized by abnormal dilation of the testicular veins, is a common condition affecting male fertility. The role of the neutrophil-to-lymphocyte ratio (NLR) as a predictive prognostic marker for varicocelectomy outcomes in improving male fertility remains uncertain. This systematic review aims to explore the association between pre-operative NLR levels and varicocele surgery outcomes. Methods A systematic literature search was performed following PRISMA guidelines, utilizing electronic databases such as PubMed, EMBASE, and Cochrane. Studies published between 2018 and 2024 were included if they examined varicocelectomy surgical outcomes and NLR levels as predictive factors. Data extraction and quality assessment were carried out independently. Results Four studies met the inclusion criteria, collectively involving 442 patients. Elevated NLR levels were associated with varicocele surgery failure, indicating the potential impact of inflammation on treatment efficacy. Pre-operative assessment of NLR levels showed promise in identifying candidates likely to benefit from varicocelectomy, thereby optimizing treatment outcomes. This is the first systematic review evaluating the prognostic utility of NLR in varicocelectomy outcomes. Elevated pre-operative NLR levels were associated with poorer surgical outcomes, highlighting their potential for pre-surgical patient stratification. Discussion The findings suggest that incorporating NLR into the pre-operative assessment of infertile men with varicocele could enhance treatment decision-making and improve overall fertility prospects. Elevated NLR levels were associated with varicocele surgery failure, suggesting the detrimental impact of inflammation on treatment efficacy. Conclusion Pre-operative assessment of NLR levels may aid in identifying candidates likely to benefit from varicocelectomy, optimizing treatment outcomes.

OBJECTIVE: To explore the advantages and clinical application value of the new technique of single-port laparoscopy combined with fascial puncture needle-assisted external abdominal wall ligation of the spermatic vein compared to traditional three-port laparoscopy in the treatment of varicocele in children and adolescents, and to compare the efficacy of both methods. METHODS: A retrospective analysis was conducted on the perioperative and follow-up data of children under 18 years old with left-sided varicocele treated in the Department of Urology, Kunming Children’s Hospital, from January to December 2022. Based on the surgical approach, patients undergoing traditional three-port laparoscopy were classified into the control group, while those undergoing single-port laparoscopy combined with a fascial puncture needle-assisted technique for external abdominal wall ligation of the spermatic vein were classified into the intervention group. General patient information was collected, including age, chief complaints, symptoms, signs, and preoperative ultrasound results. Perioperative data were recorded, including surgery duration, intraoperative blood loss, hospitalization duration, hospitalization costs, and postoperative recovery status. Two-year follow-up data included complications such as postoperative low back pain, scrotal pain, incision infection, varicocele recurrence, hydrocele, and testicular atrophy. The surgical indicators and incidence of postoperative complications were compared between the two groups. RESULTS: A total of 71 patients were included in this study, with 35 children in the intervention group and 36 children in the control group. Surgery was successful for both groups, with smooth ligation of the spermatic vein in all cases, and no changes in surgical approach. There was no statistically significant difference in surgery time between the two groups (P = 0.815 > 0.05, t = 2.630). The intervention group had lower intraoperative blood loss, shorter hospitalization time, and lower hospitalization costs compared to the control group (P < 0.050). At the 2-year postoperative follow-up, physical examinations and scrotal ultrasounds showed no testicular atrophy or postoperative low back pain in either group. During the follow-up, the intervention group had one case of postoperative recurrence (2.9%), three cases of left-sided hydrocele (8.6%), and one case of intermittent scrotal pain (2.9%), with no incision infections. In the control group, there was one case of recurrence (2.8%), five cases of left-sided hydrocele (13.9%), three cases of intermittent scrotal pain (8.3%), and one case of incision infection (2.8%). There were no statistically significant differences between the groups in the incidence of hydrocele, scrotal pain, or incision infection (P > 0.050). CONCLUSION: There is no significant difference in postoperative efficacy between the two surgical methods. However, the technique of single-port laparoscopy combined with fascial puncture needle-assisted external abdominal wall ligation of the spermatic vein bundle offers advantages over traditional three-port laparoscopy, including less surgical trauma, aesthetically pleasing incisions, less intraoperative blood loss, shorter hospitalization time, and lower hospitalization costs. This method is suitable for the surgical treatment of varicocele in adolescents.

ABSTRACTIntroductionVaricocele is a correctable cause of male infertility with management options including catheter embolisation of the testicular vein, done by Interventional Radiologists. Varicoceles can present in childhood and adolescence with scrotal pain or discomfort, or may be subclinical. It involves dilatation of the pampiniform plexus related to congestion and retrograde flow in the testicular vein. If left untreated, the pain and discomfort may impact the quality of life of the paediatric patient, and in the long term, infertility may ensue. However, limited data are available on the long‐term clinical outcomes and complications of Varicocele embolisation in paediatric patients.MethodRetrospective cohort study of 14 years of endovascular Varicocele embolisation at a single‐operator tertiary paediatric centre.ResultsEighty‐four patients with a median age of 14 years (range 8–17 years) were identified. The varicoceles were predominantly of grade 1 or 2. 99% of patients had unilateral left‐sided varicoceles. One patient had bilateral varicoceles. This study demonstrated that the technical success rate of endovascular embolisation is 94% and the clinical success rate is 98%. 84% reported feeling well in the immediate postprocedural period. 86% of cases reported excellent long‐term progress. A small proportion (10%) experienced long‐term discomfort or pain. There were no cases of relapse.ConclusionEndovascular embolisation is a successful technique for the management of Varicocele in paediatric patients, with good immediate and long‐term clinical outcomes. It has low recurrence rates.

Introduction: Varicocele, characterized as a palpable, dilated, and tortuous pampiniform plexus of testicular veins, is present in approximately 35% of men with primary infertility. While the exact mechanisms underlying varicocele-associated infertility remain unclear, evidence indicates reduced sperm concentration, impaired motility, oxidative stress, and increased sperm DNA fragmentation (SDF) as contributing factors. This study prospectively evaluates the effects of varicoceles on conventional semen parameters and SDF. Materials and Methods: Sixty semen samples from men with (30) and without (30) varicocele were analyzed to assess semen parameters and SDF. Varicocele presence was clinically evaluated and confirmed through color Doppler sonography. Semen parameters were assessed according to the World Health Organization 2021 6th edition guidelines, with sperm concentration measured using a Makler counting chamber and computer-assisted semen analysis. SDF was evaluated in both groups using the sperm chromatin dispersion test (Halosperm kit). Results for semen parameters and DNA fragmentation index were compared between the varicocele and nonvaricocele groups. Results: The study evaluates the impact of varicocele on fertility, lifestyle habits, semen parameters, and DNA fragmentation. Primary infertility was more prevalent in both groups, affecting 63.3% of varicocele and 56.7% of nonvaricocele patients. Lifestyle analysis showed significantly higher smoking (33.3%, P = 0.010) and multiple habits (26.6%, P = 0.039) in the varicocele group, while nonvaricocele patients were more likely to have no habits (56.6%, P = 0.001). Semen analysis revealed significant impairments in varicocele patients, including lower sperm count, total sperm number, total motility, nonprogressive motility, and normal morphology (P &lt; 0.05). DNA fragmentation was significantly higher in varicocele patients, with 73.3% showing &gt;30% fragmentation compared to 40% in nonvaricocele patients (P = 0.009). Normal semen parameters were observed in only 13.3% of varicocele patients compared to 60% in nonvaricocele patients (P = 0.001). Conclusions: This study highlights that infertile men with varicoceles exhibit significant abnormalities in semen quality, coupled with elevated levels of sperm nuclear DNA fragmentation, suggesting the critical role of varicoceles in male infertility.

ObjectiveAbdominopelvic vascular compression syndromes occur when the vascular structures either cause compression or are compressed by the surrounding hollow viscera. Apart from retrocaval ureter and UPJO (ureteropelvic junction obstruction), ureteric compression by other vascular structures is rare. We present five rare cases of ureter compression caused by the inferior mesenteric vein, testicular vein, ovarian vein, common iliac arteries, and an unnamed tributary of the inferior vena cava (IVC).MethodsRetrospective data of all cases of hydroureteronephrosis between January 2019 and March 2020 were studied. Out of the 659 cases identified, the search was narrowed to keywords like "vascular compression", "ureteric compression", and "crossing vessels". A total of 11 cases were identified. Excluding six cases of UPJO, we were left with five cases of extrinsic ureteric compression caused by other vascular structures.ResultsCase 1 was a 26-year-old man with ureteric compression by the inferior mesenteric vein. Case 2 was a 27-year-old man with an incidental intraoperative finding of the left testicular vein compressing the upper ureter. Case 3 was a 38-year-old female with a dilated upper ureter due to compression by the right ovarian vein. Case 4 was a 19-year-old female with compression of bilateral mid-ureters by common iliac arteries. Case 5 was a 26-year-old man with an upper ureteric stricture due to a crossing tributary of the IVC.ConclusionVascular compression of the ureter, by ovarian or testicular veins, common iliac arteries or veins, or unusual IVC tributaries, though rare, can cause proximal hydroureteronephrosis, stones, and pyelonephritis. CT urography, which includes arterial, venous, and excretory phases, is essential for accurate diagnosis. Management of such syndromes includes retrograde pyelography +/- temporary stenting and definitive minimally invasive measures like endoscopic ureterotomy, ureterolysis, and/or definitive reconstruction, effectively relieving obstruction and preventing complications.

Thrombosis of the pampiniform venous plexus is a very rare pathology, mainly affecting the left spermatic vein and is one of the causes of acute scrotal pain. It presents with initial symptoms, such as pain and testicular swelling, which may be nonspecific for thrombotic disease and they may simulate other acute local conditions. Color Doppler Ultrasound is the main examination for diagnosis. For the few cases available in the literature, the etiology and pathophysiology of spermatic vein thrombosis remain unclear and, for the same reason, the differential diagnosis and the therapeutic approach, conservative vs surgical, still raise numerous controversies. In this work, the Authors report a very particular case of left pampiniform plexus venous thrombosis that occurred in a young patient a few hours after the scleroembolization procedure for the minimally invasive treatment of varicocele.

The pathological mechanism of venous reflux in varicocoele (VC) remains unclear. The theory of vascular remodeling may play an important role. This study aims to explore the potential pathological mechanism of VC and its association with abnormal vascular remodeling in VC patients. We collected specimens of spermatic veins from VC patients who received microsurgical varicocelectomies at the Department of Andrology, the Affiliated Hospital of Qingdao University, from January 2020 to January 2024. The spermatic veins of VC patients were divided into three subgroups based on diameter (<1mm, 1-3mm, and >3mm), with a control group consisting of spermatic veins from hydrocele patients. Differences in venous morphology and ultrastructure between these groups were examined using optical microscopy (OM) and transmission electron microscopy (TEM). The expression of alpha-smooth muscle actin (α-SMA) and osteopontin (OPN) was evaluated by immunohistochemical staining and Western blot analysis. Substantial hyperplasia and disordered arrangement of smooth muscle cells (SMCs) in the spermatic veins of VC patients were observed. Thickness and clumpy aggregation of collagen fibers were also noted under OM, with a significantly higher proportion observed. An increase in dense bodies and mitochondrial vacuolization in the VC group were revealed by TEM. Immunohistochemical staining showed that both α-SMA and OPN were enriched in SMCs. Western blot analysis showed that the expression of OPN was significantly greater in the 1-3mm and >3mm subgroups compared with the control group (p<0.05), while the expression of α-SMA did not show a significant decrease. The pathological changes in morphology and overexpression of OPN in SMCs indicates a possible spermatic vascular transition from the contractile to secretory phenotype. This abnormal vascular remodeling might be associated with the reflux in the spermatic veins of VC patients.

Varicocele is characterized by the dilation and tortuosity of the internal spermatic venous plexus, leading to impaired venous return, elevated testicular temperature, and ultimately compromised sperm quality. However, most previous reviews have primarily focused on the impact of varicocele on fertility, with limited comprehensive analysis of the associated risk factors contributing to its development. Therefore, this study systematically reviews the existing literature and provides an in-depth analysis of the risk factors associated with varicocele. We conducted a literature search using PubMed, selecting peer-reviewed journal articles without time restrictions. The included publications were systematically summarized and analyzed. Varicocele predominantly occurs on the left side (90%) due to anatomical factors such as the longer left spermatic vein and its perpendicular insertion into the left renal vein, increasing hydrostatic pressure. Genetic predispositions, including polymorphisms in glutathione S-transferase (GST) and NOS3 genes, contribute to oxidative stress and venous dysfunction. Lifestyle factors such as rapid pubertal development, intense physical activity, and high-altitude residence correlate with higher incidence, while higher body mass index (BMI) may be protective. Hematological markers, including elevated platelet indices and inflammatory cytokines such as interleukin-6 (IL-6) and C-reactive protein (CRP) are linked to varicocele severity and infertility risk. Additionally, conditions like chronic obstructive pulmonary disease (COPD), chronic constipation, and autoimmune diseases like Behçet's disease exacerbate varicocele through increased intra-abdominal pressure or vascular inflammation. Varicocele is a condition with multiple contributing factors. Identifying high-risk individuals early, along with lifestyle changes and targeted treatments, may help reduce fertility problems linked to varicocele. Future research should focus on better understanding how this condition develops and improving treatment options to enhance outcomes or prevent it altogether.

Abstract Study question To examine the connection between varicocele and sperm quality, sperm DNA integrity, and sperm reactive oxygen species (ROS). Summary answer A higher grade of varicocele was associated with poorer sperm quality and higher sperm DNA fragmentation, while sperm ROS levels remained unchanged. What is known already Varicocele, the most common and treatable risk factor for male infertility, occurs by a pathological reflux of blood into the internal spermatic vein causing the elevation of scrotal temperature. The pathophysiological mechanisms of varicocele-induced infertility are scrotal hyperthermia, hypoxia and oxidative stress. Study design, size, duration This historical cohort study involved 5933 male participants from March 2021 to December 2023. All enrolled participants were required to complete scrotal ultrasonography, standard semen analysis, sperm chromatin structure assay and sperm ROS assessment on the same day. Participants/materials, setting, methods Participants were divided into four groups: no varicocele (control group, n = 3986), grade I varicocele (VCI group, n = 1525), grade II varicocele (VCII group, n = 269), grade III varicocele (VCIII group, n = 153). The Kruskal-Wallis test was utilized to analyze intergroup differences, with results reported as the median (interquartile range). Spearman correlation analysis was conducted to evaluate the correlation coefficients between varicocele and semen parameters. A two-sided P &amp;lt; 0.05 was considered statistically significant. Main results and the role of chance Total number of spermatozoa and sperm concentration were significantly lower in men with clinical varicocele compared to the control group, and were significantly lower in the VCII and VCIII groups when compared with the VCI group (P&amp;lt;0.001). The percentage of motile spermatozoa and progressively motile spermatozoa decreased in the VCII and VCIII groups compared to the control and VCI groups (P&amp;lt;0.001). The VCIII group had a lower percentage of morphologically normal spermatozoa compared to the control and VCI groups (P=0.001). Sperm viability percentages was lower in men with clinical varicocele compared to the control group, and the levels were significantly reduced in the VCII compared to the VCI group (P&amp;lt;0.001). Compared to the control and VCI groups, the DNA fragmentation index (DFI) was higher in the VCII and VCIII groups (P&amp;lt;0.001). No significant differences were found between groups regarding ROS (P&amp;gt;0.05). Varicocele was negatively correlated with total number of spermatozoa (r=-0.101, P&amp;lt;0.001), sperm concentration (r=-0.108, P&amp;lt;0.001), motile spermatozoa (r=-0.051, P&amp;lt;0.001), progressively motile spermatozoa (r=-0.046, P=0.001), morphologically normal spermatozoa (r=-0.045, P=0.001), sperm viability (r=-0.057, P&amp;lt;0.001), while it was positively correlated with DFI (r=0.051, P&amp;lt;0.001). Limitations, reasons for caution The main weakness of this study was the participants were not randomized. Wider implications of the findings Patients with varicocele who wish to have children, especially those with moderate to severe cases, should undergo treatment to enhance sperm quality. This can help them achieve natural conception or reduce the level of assisted reproduction. Trial registration number No

Цель исследования: проанализировать частоту встречаемости признаков аорто-мезентериального феномена (синдрома Щелкунчика) при рецидивах варикоцеле и определить эффективность лечения рецидивирующего варикоцеле после первичного оперативного лечения при наличии признаков феномена Щелкунчика. Материал и методы. В исследование включено 30 пациентов с рецидивом варикоцеле, ранее оперированных по поводу данной патологии методом Иваниссевича (1я группа, n = 10), методом Мармара (2я группа, n = 10) и лапароскопическим методом (3я группа, n = 10). Результаты. С помощью ультразвукового исследования проведена сравнительная оценка диаметра яичковых вен до и после хирургического лечения в зависимости от метода операции. Наибольшая разница в диаметре вен наблюдалась у пациентов, оперированных лапароскопическим методом, что свидетельствует о его высокой эффективности в устранении венозного застоя. По результатам магнитно-резонансной томографии у 18 пациентов выявлены признаки аорто-мезентериального пинцета. Для оценки влияния метода оперативного лечения на болевой синдром при рецидивах использована визуальная аналоговая шкала. Результаты показали значительные различия между группами. Заключение. Лапароскопический метод лечения рецидивирующего варикоцеле демонстрирует наибольшую эффектив ность в устранении венозного застоя, что подтверждается значительным уменьшением диаметра яичковых вен после операции, а также у пациентов с аорто-мезентериальным феноменом. Выбор метода оперативного лечения рецидивирующего варикоцеле должен основываться на индивидуальных особенностях пациента, включая наличие или отсутствие аорто-мезентериального феномена. Aim: to analyze the frequency of occurrence of signs of aortomesenteric phenomenon (Nutcracker syndrome) in recurrent varicocele and to determine the effectiveness of treatment of recurrent varicocele after primary surgical treatment in the presence of signs of the Nutcracker phenomenon. Material and methods. The study included 30 patients with recurrent varicocele, previously operated on for this patholo gy using the Ivanissevich method (group 1, n = 10), the Marmara method (group 2, n = 10) and the laparoscopic method (group 3, n = 10). Results. Using ultrasound examination, a comparative assessment of the diameter of the testicular veins before and after sur gical treatment was performed depending on the surgical method. The greatest difference in the vein diameter was observed in patients operated on laparoscopically, which indicates its high efficiency in eliminating venous congestion. According to the results of magnetic resonance imaging, signs of aortomesenteric forceps were detected in 18 patients. A visual analog scale was used to assess the effect of the surgical treatment method on pain syndrome during relapses. The results showed significant differences between the groups. Conclusion. Laparoscopic treatment of recurrent varicocele demonstrates the greatest efficiency in eliminating venous con gestion, which is confirmed by a significant decrease in the diameter of the testicular veins after surgery, as well as in patients with aortomesenteric phenomenon. The choice of surgical treatment for recurrent varicocele should be based on the indi vidual characteristics of the patient, including the presence or absence of aortomesenteric phenomenon.

Varicocele is a common cause of male infertility. Varicocelectomy can effectively improve semen quality, but it does not improve semen quality in all patients. Prior to conducting this meta-analysis, we registered the protocol in PROSPERO (CRD42024574608). Our meta-analysis by searching databases such as Web of Science, Embase, PubMed, and Cochrane Library. Only studies utilizing multivariable logistic regression were included. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the effect size. The analysis comprised 11 studies with 1,498 patients and encompassed 14 outcomes. The overall efficacy rate of varicocelectomy was 62.8% (95% CI 55.6-69.9%). Compared to other surgical methods and approaches, microsurgical varicocelectomy and subinguinal varicocelectomy demonstrated higher surgical efficacy rates. Higher preoperative sperm concentration (OR = 1.04, 95% CI 1.01-1.06) and total motile sperm count (OR = 3.00, 95% CI 1.04-8.67) were predictive of better post-varicocelectomy outcomes. Furthermore, a positive correlation existed between wider spermatic vein diameter and improved efficacy post-varicocelectomy (OR = 2.41, 95% CI 1.36-4.26). Microsurgical subinguinal varicocelectomy achieves higher surgical efficacy rates. Varicocele patients with better preoperative sperm concentration, total motile sperm count, and wider spermatic vein diameter are more likely to benefit from varicocelectomy. This provides andrologists with a reference basis for advising varicocele patients on the surgical efficacy and potential benefits post-varicocelectomy.

During routine dissection of an adult male cadaver about 50 years of age, the right testicular vein was seen to drain into the right renal vein at a right angle which is rare. At a 90° angle, the left testicular vein drain into the left renal vein. The caudal part of subcardinal vein is responsible for the development of gonadal vein and it drains into the supra-subcardinal anastomosis. In this exceptional case, the right supra-subcardinal anastomosis instead contributed to the formation of the right renal vein, which consequently received the right testicular vein. On the left side, the supra-subcardinal anastomosis is incorporated into the left renal vein, serving as the drainage site for the left gonadal vein. This pattern of drainage has to be kept in mind by the physicians as this may lead to varicocele on the right which may be implicated in male infertility

During routine dissection of an adult male cadaver about 50 years of age, the right testicular vein was seen to drain into the right renal vein at a right angle which is rare. At a 90° angle, the left testicular vein drain into the left renal vein. The caudal part of subcardinal vein is responsible for the development of gonadal vein and it drains into the supra-subcardinal anastomosis. In this exceptional case, the right supra-subcardinal anastomosis instead contributed to the formation of the right renal vein, which consequently received the right testicular vein. On the left side, the supra-subcardinal anastomosis is incorporated into the left renal vein, serving as the drainage site for the left gonadal vein. This pattern of drainage has to be kept in mind by the physicians as this may lead to varicocele on the right which may be implicated in male infertility