Spermatic Vein Research Articles

Comparison of pre-operative and post-operative (varicocelectomy) sperm parameters in patients suffering varicocle with and without reflux in Doppler ultrasonography.

Background:Varicocele can cause progressive testicular damage and infertility. Severe retrograde blood flow to the internal spermatic vein has been suggested as a risk factor for infertility or progressive/stable varicocele. We have aimed to Compared th pre-operative and post-operative (varicocelectomy) sperm parameters in patients suffering varicocle with and without reflux in Doppler ultrasonography.Methods:This descriptive-analytic study was carried out at the Imaging Center of Ahwaz University of Medical Sciences in Imam and Golestan Hospitals. The parameters assessed included the presence or absence of internal spermatic vein reflux in both sided. Patients were divided into three groups based on the presence of testicular reflux: no reflux, left-sided reflux, and both sides reflux. The reflux longer than 1 second was considered pathologic. All patients were also referred to the laboratory for semen analysis, including semen volume, sperm morphology, sperm counts, and motility. Semen analysis was repeated 2 months after varicocelectomy.Results:In this study, a total of 70 patients were evaluated. Forty-three patients (61.4%) did not have any reflux, 23 patients (32.9%) had left testicular reflux, and 4 (5.7%) had reflux in both testicles. Semen volume, number of sperms, number of motile sperm, and sperm morphology increased significantly after Varicocelectomy. We did not find any significant correlation between testicular reflux and improvement index of semen analysis factor was found.Conclusion:The findings of this study indicate that the presence of testicular reflux has no effect on semen analysis parameters, but also does not predict the consequences of varicocelectomy and therefore is not a suitable prognosis factor in varicocele patients.

May-Thurner syndrome and varicose veins of the pelvic organs in men

The study objectiveis to study the methods of diagnosis and treatment of iliac venous compression in men with urological and andrological pathology and varicose veins of the pelvic organs.Materials and methods. From 2015 to 2018, 110 patients with bilateral varicocele, varicose veins of the pelvic organs and May–Thurner syndrome in age from 17 to 69 years (mean 33.2 years) were examined. Ultrasound echography of the scrotum organs and vessels of the penis, including transrectal and Doppler mode, magnetic resonance phlebography, dynamic pharmacocavernosography were used for the examination.Results.The presence of bilateral varicocele in all patients was verified. Aorto-mesenteric compression in combination with iliac venous compression was detected in 36 (32.7 %) patients. X-ray surgical treatment of ileal venous compression syndrome was performed in 26 patients. After 3 months in all cases there was a decrease in the maximum diameter of the veins of the prostate gland. In 13 patients with isolated ileal compression (without combination with arterial aorto-mesenteric forceps), by 3 months after surgery, a reduction in varicocele was observed: in all cases the diameter of the left and right testicular veins lying and without tension was less than 2 mm.Conclusion.Angioplasty and stenting of the iliac veins in arterio-venous conflicts is a highly effective method of treating patients with varicose veins of the pelvic organs in combination with varicocele.

Pulmonary embolism by foreign bodies: a case report

The problem of pulmonary thromboembolism (PTE) continues to be highly relevant, as it remains a complex clinical problem today, in spite of modern diagnostic and treatment methods. According to WHO, PTE is recognized as one of the most common cardiovascular diseases in the world and ranks third after coronary heart disease and brain stroke. Embolism to the pulmonary artery is not always caused by thrombotic masses. There is also a non-thrombotic pulmonary embolism (NTPE), which is defined as embolization to the pulmonary arteries by different types of cells (adipocytes, amniotic, trophoblastic or tumor), fungi, septic and foreign material or air / gases. In our article, the clinical case of embolism to the pulmonary artery by foreign bodies – coils placed in the left spermatic vein for varicocele correction is presented. Despite the significant lesion area, signs of pulmonary hypertension were not revealed. Thus, the rapidly evolving potential of modern interventional medicine requires a doctor to be aware and alert as for a NTPE development. Computed tomographic angiopulmonography with the aid of intravenous contrast enhancement is the main diagnostic method for pulmonary thromboembolism as well as for non-thrombotic pulmonary embolism.

Pattern of varicocele vein blood gases in patients undergoing microsurgical Varicocelectomy

BackgroundVaricocele is known to be associated with infertility and sperm disorders. The exact cause of this ailment is not fully understood. There are limited numbers of studies where venous blood gases (VBGs) of varicocele veins were determined with conflicting results. Therefore, we have investigated the pattern of VBGs in both internal spermatic and external spermatic varicocele veins and correlation with semen quality parameters in infertile individuals who underwent left microsurgical varicocelectomy.MethodsPatients (n = 27) undergoing left microsurgical varicocelectomy at a tertiary care hospital, were included in the study. Before surgery, semen parameters and scrotal color Doppler ultrasonography was performed. During surgery, blood sample was drawn from varicocele veins (internal spermatic and external spermatic veins) and a peripheral arm vein of the same patient as a control. The VBGs of all veins under study were estimated and compared with each other. The VBGs were also correlated with various semen quality parameters. Data, expressed as Mean ± SD, regarding VBGs in three veins were analyzed using one-way ANOVA. The correlation between VBGs and semen quality parameters was determined using Pearson’s correlation. Differences were considered significant at p < 0.05.ResultsThe pH was found to be higher (p < 0.01) in the internal spermatic vein compared with the external spermatic and the peripheral veins. Partial pressure of oxygen (pO2) and oxygen saturation (sO2) were higher (p < 0.01) in the internal spermatic vein compared with the peripheral vein. However, concentration of bicarbonate (HCO3) was lower (p < 0.01) in both veins compared with the peripheral vein. Partial pressure of carbon dioxide (pCO2) was also lower (p < 0.01) in the varicocele veins compared with the control vein.ConclusionThe internal spermatic veins had higher pH and oxygen tension, but lower HCO3 and pCO2 levels compared with the control peripheral veins. External spermatic veins had lower pCO2 and HCO3 but other VBGs were similar to the peripheral veins. The shift of VBGs of internal spermatic vein toward arterial blood pattern may be a missing link to understand the pathophysiology of varicocele.

Double Inferior Vena Cava Associated with Double Suprarenal and Testicular Venous Anomalies: A Rare Case Report

Introduction The variant courses of blood vessels are very important in considerations for retroperitoneal surgeries or interventional radiology. The present study attempted to describe a very rare case of double inferior vena cava (IVC) associated with double left suprarenal veins (LSRVs) and double right testicular veins (RTVs) in a Thai male embalmed cadaver. Material and Methods A 70-year-old Thai male cadaver was systemically dissected and observed for the vascular distributions during gross anatomy teaching for medical students at the anatomy department of the faculty of medicine of the Khon Kaen University. Results We found that the double IVCs were connected with the transverse interiliac vein. While the upper LSRV is a tributary of the IVC, the lower LSRV is a tributary of the left renal vein. The RTV bifurcates at about the height of the iliac cristae to form the medial and lateral RTVs, which drain into the right IVC at different heights. Conclusion All these duplications and associated anomalies are assumed to occur during the embryological development. These anomalies are rare, but the knowledge about the possibilities of these anomalies is of great importance during retroperitoneal surgeries, and during interventional radiology.

An examination on composition of spermatozoa obtained from pre-operative and post-operative varicocele patients

Varicocele is one of the main and surgically repairable causes of male infertility, which arises from dilatation and torsion of the testicular veins in the plexus pampiniformis. In this study, we examined semen samples from 40 patients diagnosed with varicocele between the ages of 15 and 30 years, according to WHO criteria (pre-operatively, and at 3, 6, and 12 months post-operatively). The mean spermatozoa concentration was found to be 45.25 ± 34.83 million/ml pre-operatively, while the mean post-operative concentration was 48.85 ± 35.73 million/ml at three months, 51.72 ± 32.82 million/ml at six months, and 49.63 ± 28.05 million/ml at 12 months (P > 0.05). The mean rate of A + B motile spermatozoa was 35.5 ± 14.71% pre-operatively, 42.65 ± 16.80% at three months, 43 ± 13.52%at six months and 44 ± 14.76 percent at 12 months post-operatively (P < 0.05). The mean Kruger morphology score was 3.15 ± 3.0% pre-operatively, and 3.20 ± 2.83% at three months, 2.97 ± 2.61%at six months and 3.27 ± 2.50%at 12 months post-operatively (P > 0.05). The nucleus, acrosomal cap, mitochondrial structure and microtubules of the tail of the spermatozoa were examined under electron microscopy. The mean DNA fragmentation index (DFI%) of the spermatozoa was 20.57 ± 4.60% pre-operatively, and post-operatively at 17.27 ± 3.65% at three months, 15.5 ± 3.23% at six months and 15.3 ± 3.63% at 12 months (P < 0.001).The findings suggest that despite the increased count and motility, as well as the improved DNA fractures observed post-operatively in the spermatozoa of varicocele patients, the morphology rates remain intact.

Treating varicocele in 2018: current knowledge and treatment options.

Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.

18F-FDG PET/CT Findings of Non-Hodgkin Lymphoma Involving the Whole Genitourinary System

A sixty-two-year-old male patient underwent orchiectomy and was diagnosed with diffuse large B-cell lymphoma in the testicle and spermatic cord. 18F-FDG positron emission tomography/computed tomography (PET/CT) scanning was performed for initial staging. 18F-FDG PET/CT scan revealed multiple hyper-metabolic lymphadenopathies, lung lesions and mass lesions in the adrenal glands and kidneys. In addition, diffuse increased 18F-FDG uptake suggesting lymphomatous infiltration on the right testicle, prostate and left testicular veins were detected. The genitourinary system involvement is extremely rare in extra-nodal lymphomas and to the best of our knowledge this is the first case in the literature having 18F-FDG accumulating lesions in all genitourinary system structures.

Role of Percutaneous Transcatheter Embolization of Gonadal Vein Using N-Butyl Cyanoacrylate in Treatment of Varicocele

Background: Percutaneous embolization of the internal spermatic vein to treat varicoceles is a minimally invasive outpatient procedure that, when performed by experienced interventional radiologists, has high technical success rates, low recurrence rates, very low morbidity and minimal radiation. It has been demonstrated to be equal to surgical ligation in clinical results and as or more cost effective. Its minimally invasive nature allows it be well tolerated with shorter recovery times and less discomfort relative to surgery. When skilled and experienced vascular and interventional radiology services are available, embolization is an effective alternative to surgery and should be offered as such or as primary therapy for varicocele treatment. Objective: The aim of this study is to discuss the role of N-buty cyanoacrylate for gonadal vein embolization in treatment varicocele causing testicular pain or infertility. Methodology: this study was carried out in Radiology Department of Ain Shams University Hospitals. This сross seсtionaƖ desсriptive study inсƖuded 20 patients with variсoсeƖe presented ƅy pain, infertility or recurrence after surgery and diaɡnosis was confirmed ƅy uƖtrasound. Result: varicocele embolization has significant role in improving scrotal pain and infertility.

Effects of short- and long-term regular exercise on reproductive tissue in streptozotocin-induced diabetic male Wistar rats.

Reproductive disorders are one of the complications of diabetes mellitus. Since conflicting results have been obtained from different studies, which examined serum levels of cytokines in patients with diabetes, and considering the fact that the origin of cytokines cannot be accurately determined from their serum changes, attempts were made in the present study to study histological changes and testicular tissue levels of TNF-α and IL-1 in rats treated with exercise. Considering the effects of exercise in reducing blood sugar level and its complications, two types of short-term and long-term regular exercises were also considered to evaluate their effects on male reproductive tissues. In this study, 60 male rats with the weight range of 250±50 g were used and were randomly divided into six groups (10 rats each). Healthy groups included sedentary control group, and groups treated with two and eight weeks of exercise. Rats with type 1 diabetes (induced by streptozotocin) included sedentary control group, groups treated with two and eight weeks of exercise (six groups). All groups were evaluated in terms of testicular tissue levels of TNF-α and IL-1 using ELISA and the histometry of spermatogonia, primary spermatocytes, Sertoli cells, epithelial thickness, diameter of veins, and thickness of the seminiferous tubule. Histological changes resulting from diabetes, particularly in the diameter of testicular veins and a number of cells, including Sertoli, highlights the important fact that tissue perfusion in patients with diabetes is especially crucial, in a way that exercise proved useful for tissue structures by offsetting this complication. Measurement of the cytokines IL-1 and TNF-α in the current study showed that perfusion problems are more important in diabetic complications than inflammatory factors. The main result of this research is recommendation of investigating the tissue of interest for diagnosis of diabetes complications, measuring inflammatory mediators of tissue rather than evaluating their serum concentrations, and focusing on vascular complications as a major complication of diabetes. Furthermore, regular exercise could help improve the function of reproductive organs in healthy groups and prevent diabetes infertility complications to an acceptable degree in diabetic groups.

Reproductive hormones and sperm parameters after varicocele repair: An observational study

Varicocele repair (VR) is associated with improved sperm parameters in subfertile patients. We examined the association of the levels of reproductive hormones, scrotal colour Doppler ultrasound (CDU) and seminal parameters in subfertile men, before and after VR. Fifty subfertile males, with left-side varicocele, were enrolled in this retrospective study. The serum levels of FSH, LH and total testosterone (TT), along with continuous left spermatic venous reflux (SVR) and testicular volumes at CDU were evaluated, before and six months after VR by a left-side retrograde internal spermatic vein sclero-embolisation (SVE). Left-side SVR was either no longer present or significantly reduced in all patients after VR (p<0.0001). Sperm parameters, in particular, the total sperm motile count (TMC), were found significantly improved after VR (p<0.0001). Post-VR, no differences were observed in the baseline values of the reproductive hormones. Only SVR change was seen to predict TMC change (p=0.026) in the univariate analysis, while reproductive hormones change had no effect on TMC change (FSH:p=0.85;LH:p=0.44;TT:p=0.76). In conclusion, the improved sperm parameters were associated with the disappearance or reduction in SVR and not with changes in the levels of reproductive hormones after SVE. Thus, SVR change at CDU was the only predictor of improved sperm quality after VR in subfertile males.

Variations of the testicular artery and vein: A meta-analysis with proposed classification.

Variations of testicular vessels are more common than supposed. The testicular artery varies because of abnormal regression of the lateral mesonephric arteries in the fetus, whereas variations in the testicular vein are due to abnormalities in the involution of the intersubcardinal anastomosis. Such variations are usually found incidentally during surgical procedures around the renal pedicle and they often lead to complications. Several authors have attempted to classify them. However, these attempts have not been comprehensive. Therefore, the aim of this study is to provide a simple yet comprehensive classification of variations of the testicular vessels. The PubMed database was searched using keywords pertaining to the testicular vessels. The results were subjected to the Anatomical Quality Assessment (AQUA) tool analysis and were screened for appropriateness for inclusion in this study. The screening procedure yielded 31 original articles, 83 case reports, and 1 review article. Both testicular arterial and venous variations were more common on the left side (20.73% and 24.61%) than the right (12.69% and 18.4%, respectively). We classified the testicular arteries on the basis of their number (N), site of origin (O), and course (C). Similarly, the testicular veins were classified on the basis of their number (N) and site of drainage (D). The proposed classification facilitates identification, understanding, and reporting of variations of the testicular vessels by radiologists. It will also help surgeons to enhance the quality of their treatment. Clin. Anat. 31:854-869, 2018. © 2018 Wiley Periodicals, Inc.

A cadaveric study of anatomical variations of testicular veins

Abstract Background: Infertility is considered a major public health issue. A multicentric WHO study showed increased frequency of varicocele in infertile couples to vary geographically from 6% to 47%. Some theorize, varicocele results due to anatomical differences between the right and left testicular veins. This disparity is believed, leads to increase in hydrostatic pressure of the left testicular vein, which is subsequently transferred to the venous plexus, causing dilation. Hence knowledge of testicular venous pattern and its variations takes paramount importance. Aims: To study anatomy of testicular veins with focus on: a] normal and occurrence of varying number and patterns of testicular veins b] to find explanations for incidence of some anomalies c] to consider surgical significance of such variations and d] to compare the results of the present study with previous studies. Materials and methods: The study material comprised of 25 embalmed, adult human male cadavers of south Indian origin. Systematic dissection was carried out following the guidelines of Cunninghairr s Manual of Practical Anatomy. Results: On five sides, four testicular veins were found at the deep inguinal ring. On the left side, all testicular veins terminated in the left renal vein with some showing duplication. Variations in the terminations of testicular veins were seen in three of the right sides, which included termination in the right renal vein, junction of the inferior vena cava with the right renal vein and in one case following duplication, veins terminated on the anterior and lateral wall of the inferior vena cava. Conclusion: Termination of testicular veins followed standard text book pattern on the left side, however a slight increase in the duplication of veins was observed on this side. On the right side, testicular veins showed variations in the site of termination and also duplication. Knowledge of these findings can be of importance in clinical practice related to the problems of the testis.

Selecting patients for embolization of varicoceles based on ultrasonography.

Aim: The aim of the study was to assess patient selection for embolization of varicoceles based on ultrasonography. An additional objective of the work was to evaluate the results of endovascular treatment. Material and methods: From January 2015 till August 2017, 53 patients with varicoceles diagnosed in an ultrasound examination underwent endovascular treatment in the Department of Interventional Radiology and Neuroradiology in Lublin, Poland. Each ultrasound examination was performed using the Logiq 7 GE Medical System with a linear probe at 6–12 MHz using the B-mode and Doppler functions. The study was performed in both the supine and standing position of the patient. The morphological structures of the scrotum and the width of the pampiniform venous plexus were assessed. Based on clinical signs and symptoms as well as ultrasound findings, the patients were selected for endovascular treatment. This procedure involved the implantation of coils in the distal and proximal parts of the testicular vein and administration of a sclerosing agent between the coils. Results: Varicoceles were confirmed in all patients during a color Doppler scan. Diagnostic venography confirmed venous stasis or retrograde flow in the testicular vein and widened vessels of the pampiniform venous plexus over 2 mm in diameter in all patients undergoing endovascular treatment. The diagnostic efficacy of ultrasound was 100%. The technical success of the procedure was 89%. One patient had a recurrence of varicose veins (2.2%). There were no complications in any of the patients. Conclusions: Ultrasound is the preferred method in the diagnosis of varicoceles and selection for their treatment. Testicular vein embolization is a minimally invasive procedure characterized by high efficacy and safety.

573 Effectiveness and safety of microsurgical varicocelectomy for treating nutcracker phenomenon associated varicocele

The aim of our study was to access the clinical effectiveness and safety of microsurgical varicocelectomy in the treatment of male nutcracker phenomenon associated varicocele. We retrospectively analyzed 66 patients with varicocele in our institution between August 2015 and February 2017. Patients were categorized into two groups. In group 1, 35 patients with nutcracker phenomenon associated varicocele were included. Furthermore, 25 patients underwent microsurgical varicocelectomy were classified as group 1A, and the rest 10 patients underwent microsurgical spermatic-inferior epigastric vein anastomosis were classified as group 1B. Group 2 included 31 patients with varicocele alone underwent microsurgical varicocelectomy. The preoperative serum hormone levels (E2, FSH, LH, PRL), results of scrotal ultrasound and semen analysis between group 1 and group 2 were observed no significant difference except in age, BMI, T level and peak velocity ratio. There was no significant difference in preoperative value between group 1A and group 1B. However, group 1A spent less surgical time compared with group 1B (p<0.001). Significant decreases in post-operative left internal spermatic vein diameter and the reflux time without the Valsalva maneuver were observed compared with preoperative among group 1A, 1B and 2, respectively. In addition, semen parameters significantly improved at 6 months postoperatively compared with preoperative among group 1A and 1B. But, the postoperative parameters like the results of scrotal ultrasound and semen analysis showed no statistically different among group 1A, 1B and 2.

Varicocele embolization: Anatomical variations of the left internal spermatic vein and endovascular treatment with different types of coils.

To present anatomical variations of left internal spermatic vein and a comparison between treatments with hydrogel-coated and non-coated platinum coils in patients with varicocele. A total of 153 men (mean age, 27.5±6.7 [SD] years; range: 18-45 years) with left sided varicocele underwent coil embolization. Anatomic variants of gonadal vein were categorized into five subtypes (I-V). Additional venous collaterals were also recorded. Three types of coils were used (hydrogel coated platinum coils, fibered coils and non-coated platinum coils). Technical success, tolerance, efficacy and safety of hydrogel coated platinum coils were recorded. Comparison between different types of coils used was made. Fisher's exact test was used for statistical analysis. Varicoceles were classified as type I (26.1%), type II (13.7%), type III (32.1%), type IV (18.3%) and type V (9.8%). The internal spermatic vein - renal vein angle ranged from 32°-128° (mean angle, 93.5°). Technical success was achieved in 145 patients (94.8%) without complications. The mean number of coils used was 3 (range: 1-6 coils). A total of 260 hydrogel coated platinum coils in 95 patients and 135 non-coated coils in 50 patients were deployed with no complications. No differences were noted between the different types of coils used regarding embolic efficacy and safety. A 6.2% (9/145) recurrence rate and a 33.3% (14/42) fertility rate were observed. Clinical success regarding symptom relief after painful varicocele embolization was 100% (36/36) for technically successful cases. Varicocele embolization with the use of hydrogel coated or non-coated platinum coils is technically feasible and safe without complications. No superiority of one type of coil over the other was found.

With a new clip technique surgically inducing varicocele in Sprague-Dawley rats

BackgroundWe introduced and recreated a more consistent and effective experimental varicocele rat model by a new clip technique.MethodsA total of 40 rats were numbered and randomly assigned to 5 groups of 8 each, including sham surgery (Group I), conventional (Group II) and clip groups with 0.7, 0.8, 0.9 mm gap widths, respectively (Group III, IV, V). All of the rats in each group were sacrificed at 8 weeks after initial surgery, and the rats forming out with less than 1 mm diameter of left spermatic vein or no presence of the pampiniform plexus dilation were excluded from the experimental groups. The left spermatic vein (LSV) diameter, testicular weight, left kidney weight to body weight coefficients, kidney and testicular histology were determined.ResultsThe baseline mean diameter of the LSV in Group I, II and III was 0.22 ± 0.02, 0.23 ± 0.02 and 0.22 ± 0.03 mm, respectively (P = 0.7504). At 8 weeks after initial surgery, varicocele was successfully created in 6/8 (75%), 7/8 (87.5%), 3/8 (37.5%), 3/8 (37.5%) in GroupII-V, no varicocele was observed in Group I. In Group I, II and III, no pathological changes were observed and the left kidney weight to body weight coefficients showed no significant differences. The diameter of LSV was remarkably increased both in Group II and III compared to Group I (1.72 ± 0.13, 1.57 ± 0.19 and 0.25 ± 0.02, respectively), and Group II and III had a smaller testicular weight than the rats in Group I (1.67 ± 0.05, 1.62 ± 0.06, and 1.92 ± 0.12, respectively).ConclusionsWith a new clip technique, surgically inducing varicocele rat model becomes convenient and safe. This appears to improve the effectiveness of the model and this innovation may allow us to further understand the pathophysiology of varicocele.

Comparison of Two Percutaneous Approaches in Varicocele Embolization: Study of Complications, Radiations and Recurrence Rate

AbstractBackground: In this retrospective study, we will compare two approaches in percutaneous embolization of varicocele, right common femoral vein access and right internal jugular vein access, we will compare technical success, complications and recurrence rate.Aim of the Study: This study constructed, to compare two percutaneous access routes in varicocele embolization, the transfemoral and the jugular routes. It was a comparison of complications, radiations and recurrence rates.Patients and Methods: This study was retrospective study of the records of 34 male patients with clinically and radio-logically proved varicocle who were treated by percutaneous embolization, in the period from 2014 to 2016. They included two groups, Group I (17 patients) treated using the transfemoral route and Group II (17 patients) treated using jugular route. The embolic materials used included, coils (14 patients), N-butyl-2-cyanoacrylate (12 patients) and sclerosing agents or polidocanol in 8 patients. The catheters used were cobra head-5-Fr, Bern 4Fr and microcatheter (progreat 2,7F). The com-plications, time of radiation, technical success and recurrence were compared in both groups.Results: In Group I (percutaneous transfemoral route), there was failure of catheterization of right internal spermatic vein in one patient due to acute angle, while in Group II there was successful catheterization of left and right internal sper-matic vein in all (17 patients). Also, post-procedural pain was seen in 3 patients in Group I and in 2 patients in Group II. Contrast extravasation was seen in one patient in Group I, groin hematoma in 2 patients, glue migration in one patient and recurrence in 2 patients, while in Group II no vein injury, no hematoma or glue migration and recurrence was seen in one patient only. The mean procedure time and the fluoroscope time were longer in Group I as compared to Group II. In Group I the mean procedure time was 52 minutes and fluor-oscopy time was 23 minutes while in Group II. They were 40 minutes and 15 minutes respectively.Conclusion: Percutaneous embolization of varicocele is relatively safe technique and has high success rate. The percutaneous transjugular route is easy for catheterization of both right and left internal spermatic vein, while for left sided varicocele, the right common femoral vein access is easy and safe. The transjugular route has less complications, less radiation time and low recurrence rate.

Biochemical and Histological Evaluation of Protective Effect of Betaine in Experimental Varicocele Using Animal Model

Varicocele, abnormal dilatation of the spermatic vein, is one of the most common andrological disease found during a male physical examination. Oxidative stress due to varicocele has an effect on the testis tissue and often leads to infertility in men. Given the complications of varicocele surgery in adolescents, in recent years there has been a global trend towards the use of natural antioxidant substances to reduce the effects of varicoceles oxidative stress. Betaine has several noted effects related to human health and function. It has been shown that betaine has antioxidant and methyl donor properties and this is a candidate for applications in this area. This study first evaluated the antioxidant and methyl donor abilities of betaine in reduced oxidative stress caused by varicocele induction in rat. Twenty-one adult Wistar rats were divided into three groups. The control group (I), varicocele and treatment with normal saline group (II), varicocele and treatment with betaine group (III). At the end of the experiment, the lipid peroxidation, enzymic antioxidants (glutathione peroxidase, catalase and superoxide dismutase), histopathological examinations, Johnsen scores and sperm parameters were determined. Results showed a significant increase (p < 0.05) the activities of SOD (0.182 ± 0.002), CAT (0.204 ± 0.019), GPx (8.980 ± 0.132), TAC (2.186 ± 0.145) and significant reduced MDA (3.37 ± 0.183) level of group III (varicocelized rats treated with betaine) when compared to the activity of SOD (0.165 ± 0.002), CAT (0.105 ± 0.019), GPx (8.425 ± 0.132), TAC (1.163 ± 0.145) and MDA (4.057 ± 0.183) level in group II (Varicocelized rats treated with normal saline). Also our finding showed a significant increase (p < 0.05) of the Johnsen score (7.90 ± 0.619) in III group when compared to group II (5.06 ± 0.619). Based on these results it was possible to conclude that the varicocele impairs testicular function and it seems that betaine may protect the spermatogenesis cycle most probably via enhancement of antioxidant capacity and polyamine synthesis.

Simultaneous laparoscopic herniorrhaphy by totally extraperitoneal prosthesis and varicocelectomy for patients with varicocele combined with indirect inguinal hernia

Objective To assess the safety and effectiveness of simultaneous laparoscopic herniorrhaphy by totally extraperitoneal prosthesis (TEP)and simultaneous laparoscopic herniorrhaphy and varicocelectomy by high ligation with the route of TEP. Methods Clinical data of 16 patients who suffered from varicocele combined with indirect inguinal hernia, underwent the simultaneous laparoscopic herniorrhaphy by TEP and varicocelectomy by high ligation with the route of TEP from November 2013 to November 2016 were retrospectively analyzed. Varicocele was detected by color Doppler ultrasounography with the mean diameter of (3.12±0.53)mm.The intraoperative and postoperative clinical parametes including bleeding volume, recovery time of intestinal peristalsis, use of postoperative analgesia, complication, hospital stay and postoperative recovery time were recorded and analyzed. All patients were followed up for a range of 3~24 months. Results The operation was successful in all cases.The operation time was (39.8±7.6) min, the intraoperative blood loss was (6.5±3.2) mL, and recovery time of intestinal peristalsis was (7.8±0.9)h.There was no need for postoperative analgesia. The postoperative hospital stay was (3.6±0.8) d, and it took (4.9±0.8) d for the patients to go back to their normal activities. The normal diameter (1.71±0.32)mm of spermatic veins and and good testicular blood supply were detected by the ultrasounography befor discharge. No operative complications were observed. Varieocele was disappeared in all patients at 3 months postoperatively.All patients were followed up for 3 to 24 months without testicular atrophy and hydrocele. Recurrence of either varicocele or indirect inguinal hernia was not found during follow-up. Conclusions Simultaneous laparoscopic herniorrhaphy by TEP and varicocelectomy by high ligation with the route of TEP are safe and effective for patients with varicocele combined with indirect inguinal hernia with the advantage of less trauma, faster postoperative recovery, and less complication. Key words: Varicocele; Laparoscopes; Hernia, Inguinal