Testicular Artery Research Articles

A newly established strain of spontaneously hypertensive rat with a defect of ascorbic acid biosynthesis

To investigate the effects of ascorbic acid deficiency on the pathogenesis of hypertension and/or its complications, we established a rat strain with both genetic hypertension and a defect of ascorbic acid biosynthesis. The od gene (L-gulono-γ-lactone oxidase gene) of the ODS (Osteogenic Disorder Shionogi) rat, which is a rat mutant unable to synthesize ascorbic acid, was introduced into spontaneously hypertensive rats (SHR), and a novel congenic strain, SHR-od, was established. SHR-od showed scurvy when fed an ascorbic acid-free diet. Systolic blood pressure of male SHR-od began to increase at 9 weeks of age and reached 190–200 mmHg at 20 weeks of age. In 25-week-old SHR-od, ascorbic acid deficiency when fed an ascorbic acid-free diet for 6 weeks caused a remarkable reduction of blood pressure to lower than 110 mmHg. The wall to lumen ratio of the testicular artery in ascorbic acid-deficient SHR-od was lower than that of the control rats. When rats were fed a diet supplemented with ascorbic acid (300 mg/kg), ascorbic acid concentration in SHR-od was lower in the serum and liver than that in ODS rats. These results indicate that ascorbic acid could be closely related to the development of hypertension in SHR-od. We believe that SHR-od will be a useful model for experimental studies on hypertension and its complications, since all of them suffer from hypertension spontaneously and the level of ascorbic acid deficiency in these rats could be controlled at will both in concentration and duration.

The influence of ligation of internal spermatic artery (ISA) during varicocelectomy on testicular function and semen quality.

Objective: Ligation of the ISA is not rarely performed (J Urol 149:1357) during varicocelectomy procedures. However, there is much controversy on the effects of ligation of the ISA (during varicocelectomy) on testicular function post-varicocelectomy. We evaluated the influence of left ISA ligation during varicocelectomy on testicular function, sperm quality, and sperm fertilizing potential.

Incidence and post-operative outcomes of accidental ligation of the testicular artery during microsurgical varicocelectomy.

Objective: Varicocelectomy is the most commonly performed surgical treatment for male infertility. Microsurgical varicocelectomy enhances the ability to identify and preserve the testicular artery. The objective of this study was to determine the incidence of and evaluate the outcomes after accidental ligation of the testicular artery during microsurgical varicocelectomy.

Function and localization of oxytocin receptors in the reproductive tissue of rams

Oxytocin is present in the male reproductive tract and has been shown to increase contractility in the epididymis and to modulate steroidogenesis. This study investigated the effects of oxytocin in the testis in vivo, and the presence and cellular localization of oxytocin receptors in the reproductive tract of rams. During the breeding season, mature rams underwent efferent duct ligation before injection of either oxytocin (20 microg) or oxytocin plus an oxytocin antagonist (20 microg) into the testicular artery; the contralateral testicular artery received saline. Injection of oxytocin caused a significant increase (P < 0.05) in the concentration of spermatozoa collected from the rete testis. This effect was not observed after treatment with the oxytocin antagonist plus oxytocin. Western blot analysis performed using a specific oxytocin receptor antibody (020) identified a single immunoreactive band of 66 kDa in testicular and epididymal tissue. This band was present in uterine tissue but not in liver or muscle. Immunocytochemistry identified oxytocin receptors on Leydig and Sertoli cells of the testis, on epithelial cells throughout the epididymis, on peritubular smooth muscle cells in the cauda epididymidis, and on the epithelial cells and circular smooth muscle layer of the ductus deferens. These findings indicate that oxytocin can modulate sperm transport in the ram testis. A role for oxytocin in promoting sperm transit is supported by the localization of oxytocin receptors in the cauda epididymis and ductus deferens, and the presence of receptors on Leydig, Sertoli and epididymal epithelial cells provides further evidence that oxytocin may be involved in the local regulation of steroidogenesis.

HOMOLOGOUS TRANSPLANTATION OF PREPUBERTAL TESTES IN THE DOG1

The current standard of care for anorchia, the absence of both testes, is testosterone replacement therapy. Although transplantation of a single testis has been successful in a case of an identical twin (1), transplants in nonidentical siblings have not been performed. Homologous testis transplantation has been performed in sexually mature dogs, however, only one testis was transplanted, and histopathology alone was used to evaluate sperm production (2). The donor and recipient dogs in our experiment were two prepubertal (18-week-old) Beagle/Brittany littermates; the sire and dam of which shared a common ancestor. Based on results of a previous study (2), major histocompatability com- plex testing was not performed. The testes were harvested from the donor and transplanted into the recipient within 1 hour, via a prescrotal incision, by end-to-end anastamosis of the testicular artery, vein, and vas deferens. Immediately before anastamosis of the first testis, the recipient received 1000 U of heparin i.v. to reduce the risk of thrombosis. After anesthetic recovery, the dog was maintained on a course of previously successful immunosuppressive therapy and anticoagulants (2). The recipient lacked signs of graft-versus-host disease, or deleterious effects of the cyclosporine and prednisone therapy. Serum testosterone levels were monitored weekly by radioimmunoassay (Diagnostic Systems Laboratories, Webster, TX) from 18 to 39 weeks of age (see Fig. 1). Testosterone levels may fluctuate by as much as 2.5 ng/ml during a 24hr period in an individual dog, however, levels in castrated animals are consistently <0.20 ng/ml (3). A gradual increase in baseline testosterone, with mean levels approaching the normal range for a sexually mature animal (0.5–5.0 ng/ml), signals the onset of puberty (4). Figure 1: Longitudinal serum testosterone levels (ng/ml) from the day of transplantation, 18 weeks of age, through 39 weeks of age. Minimum testosterone level for a sexually mature dog is 0.20 ng/ml (indicated by dashed line).When the recipient reached 7 months of age, a human chorionic gonadotrophin (hCG) stimulation test was performed in order to determine the responsiveness of Leydig cells, which produce testosterone. The dog received 44 μg/kg hCG i.m. and serum was collected 4 and 24 hr later. Baseline testosterone was 0.83 ng/ml and increased to 1.35 ng/ml at 4 hr and 2.46 ng/ml at 24 hr, consistent with functional Leydig cells (3, 4). At 8 months of age, serum testosterone remained consistently within the normal range for a sexually mature dog. Semen was collected at 8 months of age, using an artificial vagina, in the presence of a bitch in estrus. A total of 300×106 sperm/ejaculate were present, 80% of sperm were progressively motile, and 85% were morphologically normal. All parameters are known indicators of fertility and were within normal limits for fertile dogs (3). Lack of graft-versus-host disease did not guarantee normal sperm production, as many factors and functional interactions are involved in organ maturation and spermatogenesis. At 17 months of age, the dog was bred to a bitch in estrus, which was confirmed by ultrasound to be pregnant with a litter of 4 pups. This case is the initial report of bilateral transplantation of prepubertal canine testes with subsequent maturation, semen evaluation, and proven fertility. These findings suggest that the dog may be a suitable animal model to evaluate microsurgical techniques and immunosuppressive therapies for use in prepubescent humans receiving a testis transplant. If successful, homologous transplantation among siblings would provide stable testosterone levels and restore fertility. Jennifer K. Pullium2 Peter H. Lin, and Martin J. Pinter

The nerve distribution in the testis of the cat

The autonomous innervation of the feline testis was investigated by immunohistochemistry and a modified acetylcholinesterase technique. The nerves reach the testis mainly by two routes: (1) with testicular artery and pampiniform plexus to the cranial extremity (funicular contribution), (2) from the epididymal tail to the caudal extremity (caudal contribution). Within the tunica albuginea the funicular contribution supplies the cranial two thirds, whereas the caudal third of the tunica receives its nerves via the ligamentous connection between testis and epididymal tail. The nerve bundles accompanying the testicular artery give branches to the arterial wall and the pampiniform plexus. When reaching the cranial testicular pole the bundles separate; the majority of them pass into the centrally located mediastinum testis, another large portion enters the tunica albuginea, particularly on its epididymal side. The septula testis are innervated from both sides, that is from the mediastinum and from the tunica albuginea. In the cat, contrary to other mammals, all septula are innervated. Furthermore, nerve fibers occur regularly within the testicular lobules. Generally, the testicular nerves of the cat are unmyelinated and mainly vascular nerves, but fibers are also found within the connective tissue compartments of the testis. The vast majority of all autonomous testicular nerves are postjunctional sympathetic fibers. Terminal ramifications of cholinergic fibers are exclusively observed in the wall of medium-sized arterioles within mediastinum, septula and lobuli testis. Neuropeptide Y is the most frequent peptidergic transmitter in feline testicular vascular plexuses. The amount of calcitonin gene-related peptide-positive fibers is also remarkably high in the testis, but prefers a location within the stroma of the tunica albuginea, mediastinum and septula. In the cat, Leydig cells occur not only in intertubular locations, but also as intratunical and mediastinal Leydig cells. In all three localizations solitary nerve fibers are observed between Leydig cell groups. These fibers are generally dopamin-beta-hydroxylase- and tyrosine hydroxylase-positive, some contain calcitonin gene-related peptide and, very few, substance P.

Intratesticular Doppler flow, seminal plasma nitrites/nitrates, and nonobstructive sperm extraction from patients with obstructive and nonobstructive azoospermia

Objective: To prospectively evaluate the role of intratesticular vascular flow in modulating sperm function in men with obstructive and nonobstructive azoospermia. The correlation of testicular Doppler values with nitric oxide and testicular sperm extraction was further evaluated. Design: Prospective study. Setting: Assisted reproduction unit at a university center. Patient(s): Twenty-eight men with azoospermia undergoing sperm extraction for intracytoplasmic sperm injection. Intervention(s): Ultrasound and color Doppler scanning of the testes. Testicular sperm retrieval and nitrite/nitrate assay. Main Outcome Measure(s): Doppler analysis of testicular transmediastinal artery, plasma and seminal plasma nitrite/nitrate values, and sperm extraction histopathology. Result(s): The pulsatility index (PI) of the transmediastinal artery was higher in patients with nonobstructive azoospermia (PI = 1.40 ± 0.13) than in those with obstructive azoospermia (PI = 1.09 ± 0.15; P=.011). Seminal plasma nitrite/nitrate concentrations were more elevated in cases of obstructive azoospermia than in gonadal failure. Unsuccessful sperm recovery was observed in four patients who showed the worst indices of gonadal failure. In this subgroup, a transmediastinal PI value >1.50 was always observed. Conclusion(s): Doppler analysis of the transmediastinal artery and nitrite/nitrate seminal plasma concentrations are useful for distinguishing between obstructive and nonobstructive azoospermia and allow the identification of the presence of spermatozoa within the testes.

Results and complications of laparoscopic surgery for pediatric varicocele

Background: The aim of this study was to evaluate the results and complications of laparoscopic varicocelectomy in children. Methods: Over a 36-month period, 211 children underwent laparoscopic treatment of varicocele. Their ages ranged between 6 and 17 years; the varicocele was located on the left side in 209 cases (99.1%) and was bilateral in 2 (0.9%). In 195 patients the laparoscopic transperitoneal approach was used and in 16 retroperitoneoscopy was used. Thirty children (14.2%) underwent ligation of the veins alone, and 181 (85.8%) underwent ligation of testicular veins and artery. In 15 (7.1%) cases an additional procedure was applied during the same operation. Results: Average operating time was 30 minutes and hospitalization about 24 hours. At an average follow-up of 26 months, there were 19 (9%) postoperative complications: 14 children had a left hydrocele, 3 children a scrotal emphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicocele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo's. Testicular atrophy did not occur in any patient of this series. Conclusions: This preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. The ligation of testicular veins and artery is preferable to the ligation of the testicular veins alone. Hydrocele seems to be the most frequent postoperative complication and a potential problem, especially in children operated on with the Palomo procedure. J Pediatr Surg 36:767-769. Copyright © 2001 by W.B. Saunders Company.

TESTICULAR INFARCTION ASSOCIATED WITH PROTEIN S DEFICIENCY

Protein S deficiency is a rare inherited disease in which a defect in the natural coagulation inhibitor protein S predisposes patients to thrombosis. Manifestations of protein S deficiency commonly include superficial and deep venous thrombosis, and pulmonary embolism. Mesenteric, myocardial and cerebral infarctions have been reported less frequently. To our knowledge we report the first case of testicular infarction due to protein S deficiency which manifested as acute scrotal pain. Our case might indicate the need to extend the concept of classic risk factors for testicular infarction in young patients. CASE REPORT A 17-year-old man had protein S deficiency and was taking prophylactic warfarin anticoagulant therapy. He had had several episodes of lower leg deep vein thrombosis during the last 7 years. He was admitted to our hospital with multiple ulcerative wounds and a painful, erythematous and swollen lower left leg. Lower left abdominal cramping occurred followed by left scrotal pain and rapid swelling. Physical examination revealed a red, swollen and tender left testicle. Pain was exacerbated by lifting the testicle above the pubic symphysis. Urinalysis showed 25 to 50 red blood cells per high power field but no pyuria. White blood count was 13,530/mm. 3 (normal 4,000 to 10,000), prothrombin time 17.4 seconds (normal 10.7 to 13.0) and activated partial thromboplastin time 38.3 seconds (normal 25 to 33). Doppler ultrasonography revealed a swollen and heterogeneous texture of the left testis with no Doppler signal of blood flow (fig. 1). Exploratory surgery was performed since the possibility of testicular torsion could not be ruled out. The left testis was explored through a scrotal incision. On gross examination the testis and epididymis were edematous, congested and darkened but the spermatic cord was in the normal position without torsion. Therefore, left orchiectomy was performed. Hemorrhagic infarction was evident on pathological examination. Microscopic examination revealed that thrombosis of the spermatic artery had resulted in testicular infarction (fig. 2). DISCUSSION

Laparoscopic varicocelectomy with preservation of the testicular artery in adolescents

Purpose: The aim of this study was to determine if laparoscopic varicocelectomy (LV) with preservation of the testicular artery (TA) is a satisfactory alternative to standard open surgical techniques in adolescents. Methods: Between June 1993 and June 1999 left LV was performed on 40 boys, median age, 12 years (range, 9 to 16 years). Selection for surgical correction included size of the varicocele, symptoms, and clinical or ultrasound assessment for testicular hypotrophy. Eight patients had undergone previous left-sided inguinal surgery, 5 of these for varicocele. Three laparoscopic ports were used. The TA was identified and preserved with the aid of a Doppler flow transducer (“Smart Needle”). All the testicular veins were ligated and divided. The inferior epigastric (IE) veins also were ligated in 19 patients. The operating time was a mean of 1 hour. The postoperative follow-up for a median of 19.5 months (range, 3 to 36 months) included clinical and ultrasound assessment. Results: Preoperative assessment confirmed left-sided testicular hypotrophy 35 patients (88%). Thirty-eight varicoceles were stage 3, and 2 were stage 2. Testicular discomfort was present in 13 patients. Complete correction of the varicocele was achieved in 33 (83%). At a mean of 5 months after LV open repair in 7 patients confirmed a dilated cremasteric vein connecting to the IE veins. Ligation of the IE veins at the time of LV was associated with a persistent varicocele in 3 of 19 patients (16%), similar to the nonligated group, 4 of 21 patients (19%). Five patients (12.5%) had a mild hydrocele. The left testicular volume increased 30% to 50% in 28 patients (70%) at a median of 6.5 months after repair. Testicular atrophy did not occur in any patients. The majority of patients went home within 6 hours of surgery. Conclusions: The laparoscopic technique with preservation of the TA is an acceptable alternative to open surgical treatment of varicoceles. Further, it eliminates the risk of testicular atrophy and is the technique of choice when previous inguinal surgery has been performed. Ligation of IE veins was not associated with a decrease in the persistence of varicocele postoperatively. J Pediatr Surg 36:394-396. Copyright © 2001 by W.B. Saunders Company.

Aspectos morfológicos do funículo espermático de jumentos (Equus asinus -- Linnaeus, 1758) da raça Pêga

We have studied morphologic aspects of 38 pairs of spermatic cord in Pega donkey, and histologically observed that their components are involved for a slim capsule of dense connective tissue. Bellow this capsule we find internal cremaster muscle that shows distinct layer or arises septate by dense connective tissue invasion. Funicular capsule and muscular tissue form disordered plicae and also some expansions that sometimes are followed for intervascular loose connective tissue. Involving funicular arteries and veins, we identified loose connective tissue with elastic and reticular fibbers, with arteriolae, venulae, nerves and lymphatic. Testicular artery studied has sinuous course, internal tunica formed by endothelium and connective tissue, with outstanding internal elastic limiting lamina. Tunica media shows to be formed for smooth musculature, supported by a rich and orderly net of reticular fibbers and few elastic fibbers, while external tunica, constituted of dense connective tissue, with collagenous and elastic fibbers, has continuity with intervascular loose connective tissue. Testicular veins, involving testicular artery, to form venous pampiniform plexus and show variable caliber, a developed tunica media, constituted of smooth muscular fibbers supported by a irregular net of reticular fibbers and few elastic fibbers. Testicular arteries segments of spermatic cord have mean, maximum and minimum lengths, respectively, of 71.34 cm, 108.9 cm and 41.6 cm at the right, and 68.78 cm, 110.4 cm and 41.6 cm at the left, and do not have statiscally significant differences, at level of 5%. Spermatic cord has a conical shape, latero-laterally flattened, with basis settled over orchis epididymal edge.

Varicocele in pediatric patients: comparative assessment of different therapeutic approaches

Objectives. The best therapeutic approach for varicocele correction in pediatric patients is still an object of some debate. We analyzed a series of 99 patients to identify the most effective approach in terms of low recurrence rates and preservation of testicular growth. Methods. One hundred four operations were performed on 99 patients between 9 and 16 years of age (mean 13.3). The first 18 patients underwent sclerotherapy of the internal spermatic vein. Twenty others underwent inguinal varicocelectomy. In 12 patients, a modified Palomo procedure (ie, sparing of the internal spermatic artery) was performed (four laparoscopically), and 54 were treated with the original Palomo procedure (ie, sectioning of the entire spermatic cord), using laparoscopy in 20. Results. Three recurrences (16.6%) occurred among the patients treated with sclerotherapy. Similar rates of recurrence were observed in those who underwent inguinal varicocelectomy (3 [15%] of 20) and modified Palomo procedures (2 [16.6%] of 12). Only one recurrence occurred in the 54 patients treated with the original Palomo procedure (1.85%). Conclusions. Our experience, together with a review of published reports, leads us to believe that the open Palomo procedure as originally described is the most effective approach to the correction of varicoceles in adolescents.

Origens e ramificações das artérias mesentéricas cranial e caudal em fetos de caprinos da raça Saanen (Capra hircus -- Linnaeus, 1758)

Estudaram-se as origens e ramificacoes das arterias mesentericas cranial e caudal que se destinam as visceras abdominais, em particular aos estomagos e intestinos de caprinos da raca Saanen, com o intuito de conhecer os pormenores da circulacao arterial destes orgaos. Utilizaram-se, para tanto, 30 fetos (19 machos e 11 femeas). Adotou-se a metodologia de dissecacao dos vasos, previamente injetados com solucao de latex Neoprene 450, corada com pigmento especifico. A arteria mesenterica cranial originou-se da arteria aorta descendente abdominal, caudalmente a arteria celiaca em 93,33% dos casos e em tronco comum (tronco celiacomesenterico) em 6,66% dos casos, e emitiu, a seguir, os seguintes ramos: ramos adrenais esquerdos (100%), ramos adrenais direitos (100%), ramos pancreaticos (96,66%), arteria pancreatico-duodenal caudal (100%), arteria colica media (96,66%), arteria ileocecolica (100%), arterias jejunais (100%) e arteria pancreaticocolica (3,33%). A arteria mesenterica caudal originou-se da face ventral da arteria aorta descendente abdominal em 100% das observacoes e emitiu as arterias colica esquerda e retal cranial em 100% dos casos e, em 3,33% das preparacoes, deu origem a arteria testicular esquerda.

Vasculature of Testis, epididymis and ductus deferens of Rabbit. The Arteries.

Rajtova V., J. Danko: Vasculature of testis, epididymis and ductus deferens of Rabbit. The Arteries. Acta Vet. Brno 2001, 70: 3-7. The vasculature of the testis, epididymis and ductus deferens was studied in twenty adult rabbits using X-ray apparatus. For filling the roentgen-contrast and also colour-contrast mass we used red lead in 10 % warm gelatin. We found an irregular origin of the bilateral aa. testiculares from the aorta. The testicular artery forms, after its pars recta, the pars convoluta with 13-20 loose loops inside the entire inguinal canal. It enters the parenchyma, then encircles the testis twice under the tunica albuginea. The r. rete testis is one of the intratesticular branches, which passes through the mediastinum testis. The rr. interlobulares originate from the r. rete testis. The epididymis is supplied by rr. epididymales (cranialis, media and caudalis) and the a. epididymalis caudalis. The spermatic duct is vascularized by the a. ductus deferentis originating from the common trunk of the a. iliaca externa. The cremaster muscle supplies the branches of the a. cremasterica and r. cremastericus from the a. ductus deferentis. Several intratesticular anastomoses were found between the parenchymal part of the a. testicularis and the rr. epididymales and also the a. epididymalis caudalis. Our study complets the arterial vasculature of the testis, epididymis and ductus deferens of rabbit.

Effects of acute graded reductions in testicular blood flow on testicular morphology in the adult rat.

The effect of moderate reductions in testicular blood flow has not been studied systematically. The aim of this study was, therefore, to examine the effects of different degrees of blood flow reduction on testicular morphology and to determine how much flow can be reduced before damage occurs. The subcapsular testicular artery was partially ligated in the left testes of adult rats. Testicular blood flow was measured before, immediately after, and 5 h after the ligation using laser Doppler flowmetry. After 5 h of partial ligation, the testes were removed, and their morphology was examined and related to the degree of blood flow reduction. The number of in situ end-labeled- or TUNEL-positive (i.e., dying) germ cells and the volume density of intravascular polymorphonuclear (PMN) leukocytes were measured. When flow was reduced to approximately 70% or less of its pretreatment value, a dose-related increase in the number of dying spermatogonia and early spermatocytes was seen. The PMN leukocytes accumulated in testicular blood vessels after partial ligation, and the maximum number was observed in testes where flow was reduced by approximately 50% of the pretreatment value. In conclusion, early stages of spermatogenesis are sensitive to a moderate, acute reduction in blood flow. Discrete reductions in flow may, therefore, have a large impact on sperm production.

Laparoscopic ligation of testicular veins for varicocele in children. A report of 180 cases.

The technique of the laparoscopic treatment of varicocele in children is described, and its outcome is discussed. A total of 180 patients from 6 to 14 years of age were studied. All of them had left-sided varicocele; 10 of them were recurrences after treatment by other methods. Varicocele was diagnosed on physical examination and confirmed by Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the spermatic artery and tinted lymphatic vessels, followed by double ligation of the spermatic veins. There were no intraoperative or postoperative complications and only one case of recurrence (0.6%). The suggested technique for laparoscopic varix ligation is a highly effective and reliable method for the treatment of pediatric varicocele. It provides the minimal invasiveness of the approach, effective microsurgical quality of visualization, and dissection with guaranteed preservation of the spermatic artery and lymphatic vessels, along with very low rates of complication and recurrence.

Longitudinal Differences in Vascular Control Mechanisms in Isolated Resistance Arteries of the Rat Cremaster Muscle

The purpose of this study was to determine if there are intrinsic differences in resting tone, vascular reactivity, myogenic responses, and neurogenic vasoconstriction between the large and small feeder arteries and first order arterioles (1A) of the rat cremaster muscle. The pudic-epigastric artery (PEA), external spermatic artery (ESA), and 1A were isolated and changes in vessel diameter were recorded in response to: (1) increases in intralumenal pressure, (2) inhibition of nitric oxide synthase (NOS), (3) norepinephrine (NE), (4) acetylcholine (ACh), and (5) perivascular nerve stimulation. Vessel responses to Ca2+-free physiological salt solution were measured to assess resting tone, which was significantly greater in the ESA and 1A compared to the PEA. NE caused a significant constriction of all vessels, with 1A exhibiting the greatest sensitivity. NOS inhibition did not alter vascular sensitivity to NE, but enhanced resting tone in ESA and 1A. ACh induced significant dilation in ESA and 1A, with minimal effect on PEA. The myogenic response was not different between ESA and 1A, but was minimal in PEA. Perivascular nerve stimulation induced a significant vasoconstriction in all vessels tested. These results suggest that the relative importance of different vascular control mechanisms varies substantially at different levels of the cremasteric arterial network and that the ESA and 1A may be the major site of active vascular regulation upstream from the cremaster muscle microcirculation.

LAPAROSCOPIC TREATMENT OF PEDIATRIC VARICOCELE: A MULTICENTER STUDY OF THE ITALIAN SOCIETY OF VIDEO SURGERY IN INFANCY

We report preliminary results of a multicenter study of the Italian Society of Video Surgery in Infancy on the laparoscopic treatment of pediatric varicocele. A total of 161 children 6 to 16 years old (median age 12.5) underwent laparoscopic treatment of varicocele at 6 pediatric surgery divisions. Varicocele was on the left side in 159 cases (98.7%) and bilateral in 2 (1.3%). Two boys had recurrent left varicocele. All children were treated with laparoscopy, including ligation of the spermatic veins only in 28 (17.3%), and ligation of the testicular veins and artery in 133 (82.7%). In 10 boys (6.2%) an additional procedure was done simultaneously, including closure of an apparently patent peritoneal vaginal duct on the right side in 7 and resection of epiploic adhesions between the intestinal loops and abdominal wall from previous appendectomy in the remaining 3. Average operative time was 30 minutes and hospitalization was about 24 hours. At followup there were 13 minor complications (8%), including left hydrocele in 9 children who underwent the Palomo technique, minor scrotal emphysema in 2 and umbilical granuloma in 2. In our series varicocele recurred in 1 boy (3.5%) who underwent ligation of the spermatic veins only and in 3 (2.2%) treated with the Palomo technique. Our preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows treatment of other intra-abdominal pathological conditions using the same anesthesia, as in 10 patients in our series. We believe that ligating the testicular veins and artery is preferable to ligating the testicular veins only, even if the incidence of hydrocele is not negligible after the Palomo procedure.

Microsurgical subinguinal varicocelectomy.

Varicocele is the most frequently observed surgically correctable cause of male infertility. Traditional approaches to the surgical repair of varicocele include retroperitoneal and inguinal operations. The incidence of persistent or recurrent varicocele following surgical repair in adults varies from 5 to 45%. Attempts at decreasing the complication and recurrence rates following varicocelectomy have included microsurgical approaches. These methods have the advantage that the testicular artery and lymphatics can be identified and preserved. The use of some microsurgical methods can also decrease the incidence of hydrocele formation and testicular artery injury. We describe our microscopic procedure and report the results obtained with this method.

Vasectomy reversal.

Vasectomy reversal.