Abstract:
We examined 67 adolescents aged 11 to 14 years referred for left varicocele. Atrophy of the testes was present in 38 (75%). Several techniques, including laparoscopic surgery were used. The best method appears to be ligation of the spermatic veins via an inguinal approach without touching the artery if possible. Recurrence (5%) is always caused by missing a vein. Growth of the testis occurred in all cases after treatment of the varicocele.Keywords:
Testicular atrophy
Spermatic Vein
Testicular artery
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Testicular artery
Spermatic Vein
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Citations (43)
Objective To discuss the effect of testicular artery ligation or not in laparoscopic high ligation of spermatic vein on testicular.Methods Twenty patients treated by spermatic vein and testicular artery cluster ligation in laparoscopic high ligation of spermatic vein were selected as observation group in this study,20 patients with simple ligation of the inside spermatic vein treated by clinical application of laparoscopic were selected as control group,they were followed up after operation of six months,a year and two years,testicular blood supply (according to the index of measuring the testicular artery blood flow velocity),testicular size and raw spermatogenic function changes of two groups in the preoperative and postoperative were compared and analyzed,and the incidence of complications were observed.Results The postoperative clinical observation for two years,the values of testicular artery blood flow velocity and observation group was similar compared with before operation,there was no significant difference between before and after surgery (P 0.05).Testicular volume of observation group had no narrowing (P 0.05).In addition,the semen quality of two groups were significantly improved after surgical treatment,there was one patient with a small amount of effusion in the tunica vaginalis were found in observation group in the follow-up,and control group had no complications,there was no significant difference between two groups (P 0.05).Conclusion Spermatic vein and testicular artery cluster ligation in laparoscopic high ligation of spermatic vein has no significant impact to the testicular artery ligation cluster arterial blood supply to the testis and the spermatogenic function without testicular atrophy.So the operation is safe and feasible.
Testicular artery
Spermatic Vein
Spermatic cord
Ligature
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Objective To explore the effect of internal spermatic vein high ligation with different operation methods on treatment of patients with varicocele. Methods A total of 168 patients with primary varicocele were randomly divided into total spermatic cord ligation group( n = 56),testicular artery preservation group( n = 56) and venous ligation group( n = 56). The semen quality,short and long term complications,fertility,recurrence and FSH before operation and 6 months after operation were compared among three groups. Results After operation,the sperm density,sperm motility,sperm deformity and FSH concentrations significantly improved in all the groups( P0. 05),and of the three groups,the degree of improvement was the greatest in the venous ligation group,while was the worst in the total spermatic cord ligation group( P0. 05). The incidence rate of postoperative secondary hydrocele in the venous ligation group was significantly lower than that in the other two groups( P0. 05). The incidence rate of testicular atrophy in the total spermatic cord ligation group was significantly higher than that in the other two groups( P0. 05). The pregnancy rate of the vein ligation group was significantly higher than that of the other two groups( P0. 05). Conclusion Application of surgical method of ligating internal spermatic vein only and preserving testicular artery and spermatic lymph pipeline can effectively improve sperm quality of patients with varicocele,reduce postoperative complications and improve pregnancy rate of spouse.
Spermatic Vein
Spermatic cord
Testicular artery
Hydrocele
Ligature
Testicular atrophy
Semen quality
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OBJECTIVE To evaluate the efficacy, in terms of recurrences, complications and operative duration, of a new technique for treating varicocele. PATIENTS AND METHODS Between September 1999 and December 2002 we evaluated 307 men aged 17–51 years with varicocele. In all of the men the clinical diagnosis was confirmed by ultrasonography. The men were treated by a variant of the microsurgical technique described in 1994. A 2–3 cm distal subinguinal incision was made at the level of the superficial inguinal ring and the spermatic cord was exposed. The largest vein in the spermatic cord fat was cannulated. A 7–9 cm segment of the spermatic cord was clamped for 8–10 min; at the start of the ischaemia time, 1.5–3 mL of 3% atoxysclerol was injected into the cannulated vein. After sclerotherapy, the vein was ligated at the injection site, and the blood flow to the cord was restored. RESULTS The mean operative duration was 25 min. Follow‐up at 3 and 6 months after surgery, with objective examination and scrotal ultrasonography, revealed one case of clinical recurrence/persistence. The most common complication was penile lymphangitis (nine men) that regressed spontaneously; three men had temporary orchialgia. There were no cases of secondary hydrocele or testicular atrophy. CONCLUSIONS The modified technique appears to be relatively easy and safe, and to of low cost. Given the promising results in terms of complications and persistence, the treatment appears to be a suitable first‐line approach for the surgical treatment of varicocele.
Spermatic cord
Hydrocele
Spermatic Vein
Testicular atrophy
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Citations (39)
To explore the effect of spermatic vein ligation under the microscope in the treatment of varicocele (VC).A total of 120 VC patients received in our department from September 2011 to February 2015 were randomly divided into an experimental and a control group of equal number, the former treated by microscopic spermatic vein ligation and the latter by conventional open high ligation. Comparisons were made between the two groups of patients in the internal diameters of the spermatic vein during eupnea and Valsalva maneuver, the reflux time of the spermatic vein, blood flow parameters of the testicular artery, and semen quality before and at 3 months after surgery.At 3 months after surgery, the experimental group, as compared with the control, showed significantly decreased reflux time of the spermatic vein (［0.41 ± 0.10］ vs ［1.08 ± 0.10］ s, P <0.05) and peak systolic velocity (9.26 ± 1.35 vs 10.64 ± 1.28, P <0.05) and resistance index (0.52 ± 0.03 vs 0.61 ± 0.03, P <0.05) of the testicular artery but markedly increased internal diameters of the spermatic vein during eupnea (［1.63 ± 0.07］ vs ［1.59 ± 0.06］ mm, P <0.05) and Valsalva maneuver (［1.72 ± 0.05］ vs ［1.68 ± 0.07］ mm, P <0.05), sperm concentration (［46.84 ± 5.24］ vs ［35.35 ± 4.26］ ×10⁶/ml, P <0.05), sperm motility (［63.75 ± 7.73］ vs ［53.87 ± 6.46］ %, P <0.05), and total sperm count (［89.54 ± 7.95］ vs ［75.24 ± 8.43］ ×10⁶/ml, P <0.05).Microscopic spermatic vein ligation has a definite effect in the treatment of varicocele, which can significantly improve the testicular blood flow and semen quality of the patient.目的： 探讨显微镜下精索静脉结扎术对精索静脉曲张患者的治疗效果。方法： 选择2011年9月至2015年2月来我院进行治疗的精索静脉曲张患者120例，随机分为试验组和对照组，各60例。试验组行显微镜下精索静脉结扎术，对照组患者行传统开放高位结扎术。对比手术前后两组患者平静呼吸和作Valsalva 动作后精索静脉内径、精索静脉返流时间、睾丸包膜动脉血流数值和精液质量。结果： 组间比较显示，术后3个月试验组患者精索静脉返流时间显著短于对照组患者［（0.41±0.1) s vs (1.08±0.1) s，P<0.05］，术后3个月试验组患者精索静脉最大内径在静息、Valsalva动作状态下均超过对照组［（1.63±0.07) mm vs (1.59±0.06) mm，(1.72±0.05) mm vs (1.68±0.07) mm，P均<0.05］；术后3个月试验组患者睾丸包膜动脉收缩期最大流速（PSV）（9.26±1.35 vs 10.64±1.28，P<0.05）、血管阻力指数（RI）（0.52±0.03 vs 0.61±0.03，P<0.05)均较对照组明显减少；术后3个月试验组患者精子浓度［（46.84±5.24）×10⁶/ml vs （35.35±4.26）×10⁶/ml，P<0.05］、精子活率［（63.75±7.73）% vs （53.87±6.46）%，P<0.05］及总精子计数［（89.54±7.95）×10⁶/ml vs （75.24±8.43）×10⁶/ml，P<0.05）］均高于对照组。 结论： 本研究结果显示，显微镜下精索静脉结扎术疗效确切，可以有效改善睾丸血流，提高精液质量，值得临床推广。.
Spermatic Vein
Testicular artery
Valsalva maneuver
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Testicular atrophy
Testicle
Orchiectomy
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Citations (19)
Objective:To assess the influence of spermatic vein and artery ligation on testicular hemodynamics,spermatogenesis and testis volume in varicocele patients.Methods:Eighty-eight varicocele patients were randomly divided into a spermatic vein and artery ligation(n=46) and a spermatic vein and artery preservation group(n=42).The testicular hemodynamic parameters, testis volume and results of semen analyses were obtained before and 6 months after the surgery and compared between the two groups. Results:There were no significant differences in peak systolic velocity(Vmax),end diastolic velocity(Vmin),mean enveloped velocity (Vmean) and Vmin of the capsular artery(CA) either between the ligation and preservation groups(P0.05) or between pre- and post-operation(P0.05).Sperm density,vitality and motility were significantly improved after surgery(P0.01),with no significant differences between the two groups(P0.05).No significant difference was found in the testis volume between the two groups before and after the operation(P0.05).Conclusion:Spermatic vein and artery ligation in varicocelectomy does not affect the testicular hemodynamics,spermatogenesis and testis volume of varicocele patients.Both the spermatic vein and artery should be ligated when necessary.
Testicular artery
Spermatic Vein
Testicle
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Citations (2)
Objective To explore the significance of laparoscopic high ligation of spermatic vein in keeping the testicular arteries for the treatment of varicocele.Methods A total of 156 patients with varicocele were randomly divided into group A and B.Patients in group A received laparoscopic high ligation of spermatic vein to reserve the testicular arteries and patients in group B received traditional Palomo operation.The semen quality parameters before and after surgery,and the incidence of postoperative complications of the two groups were compared.Results The surgery time of group A was(32.24±8.35)min,which was significantly shorter than that of group B[(36.45±9.14)min,P0.05].The rates of postoperative scrotum edema(2.67%),epididymitis(4%),and testis atrophy(2.67%)of group A were lower than those of group B(P0.05).There was no statistical difference in hospital stay and postoperative recurrence rate(P0.05).The postoperative sperm count and live sperm rate of group A were(43.00+4.3)×106 and(65.00+4.55)%,which were significantly higher than those of group B(P0.05).There was no difference in sperm density and sperm vitality between the two groups(P0.05).Conclusion Reserving testicular arteries in laparoscopic high ligation of spermatic vein can significantly improve the quality of postoperative semen parameters,reducing the incidence of scrotal edema,epididymitis,and testicular atrophy.
Spermatic Vein
Testicular atrophy
Testicular artery
Epididymitis
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5 to 25% of male adolescents present with a varicocele; only those cases inducing serious discomfort or affecting the development of the testis require surgical treatment. Nevertheless, the results of surgery are disappointing, with a high recurrence rate. Based on a better knowledge of testicular venous drainage, it appears that conventional high ligation of the spermatic vein (s) might not be sufficient to cure varicocele. Fifty-eight patients were operated upon using four different procedures. Only complete, proximal ligation of all of the visibly dilated veins seems to prevent recurrences with a follow-up of at least one year. However, out of eleven cases treated with this original procedure, one patient, already operated upon twice without success, developed secondary atrophy.
Testicular atrophy
Spermatic Vein
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Citations (1)
Objective To evaluate the effect and value of laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery in the treatment of varicocele. Methods To investigate the safety and efficacy and summarize the treatment outcome,complications and surgical experience,the clinical data of 700 patients who underwent laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery from January 2007 to January 2014 in our department were retrospectively analyzed. Results 700 cases of varicocele patients,aged 16 to 46 years( mean 27 years),482 unilateral and 218 bilateral,were all underwent laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery. Titanium clip,ultrasonic scalpel and silk were applied in 150 cases,200 cases and 350 cases for the ligation of the spermatic vein. The operation time was 30 min to 1h,the average time was 43min; the hospitalization time was 3 to 5 days. Most patients achieved satisfactory therapeutic effect to get significant improvement in the scrotum bulge discomfort and quality of infertility sperm compared with the preoperative patients. 18 patients occurred intra- operative subcutaneous emphysema,after surgery,12 cases occurred hydrocele,8 cases occurred orchitis and 5 cases recurrence. All of them were cured after conservative treatment or secondary surgery. No cases of the vas deferens damage and testicular atrophy occurred. Conclusions Laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery,retaining testicle blood supply to a greater extent,with advantages of simple,minimally invasive,fewer complications,reliable effect and faster recovery,etc.,especially proper for bilateral varicocele,patients with history of groin surgery,recurrence cases,is a valuable method of varicocele treatment,can be the preferred method of surgical treatment.
Testicular artery
Spermatic Vein
Testicular atrophy
Hydrocele
Spermatic cord
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