Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis
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Abstract:
To evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation.In all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3-12) months.The mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%.Microscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the 'gold standard' for varicocelectomy.Keywords:
Hydrocele
Spermatic cord
Spermatic Vein
Spermatic Vein
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Varicocele is the most common correctable cause of male infertility. It is found in 35 and 80% of patients with primary and secondary infertility respectively. The most effective treatment for varicocele is surgery. Varicocelectomy is associated with a lot of complications, hydrocele is the most common of which, and it affects about 20% of patients. Many techniques have been done to reduce the incidence of postvaricocelectomy hydrocele which is difficult to be done here nowadays. In this study we decided to do Jaboulay's operation (the operation for hydrocele) at the same time of varicocelecto my .We applied this maneuver for 76 patients and of course and we got no postoperative hydrocele. So we recommend combining Jaboulay's operation with varicocelectomy for all patients with varicocele to avoid the occurrence of hydrocele and the need for a second surgery. ﺔﻴﻠﻤﻋ ﺞﻤﺩ ﻲﻟﻭﺒﺎﺠ ﺍ ﻲﻟﺍﻭﺩ لﺎﺼﺌﺴﺍ ﺔﻴﻠﻤﻋ ﻊﻤ ﺔﻴﺌﺎﻤﻟﺍ ﺔﻠﻴﻘﻠﻟ ﺔﻴﺼﺨﻟ
Hydrocele
Concomitant
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Spermatic Vein
Nephrology
Renal vein
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[Objective]To explore the clinical effects of the high ligation of spermatic vein via retroperitoneum for varicocele.[Methods]65 cases with varicocele in the left were treated by the surgical approach and the effects were observed.[Results]The operations on 65 cases were all successful.The symptoms of varicocele disappeared.[Conclusion]High ligation of spermatic vein via retroperitoneum for varicocele is one of the surgical approaches,which is cheaper,simpler and with less wounds and higher cure rate.
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The aim was to evaluate the value of ultrasound diagnosis of spermatic cord hydrocele as a cause of inguinal swelling or mass in children. Clinical and ultrasound (US) findings and surgical procedures of 27 children with spermatic cord hydrocele were reviewed. All children, except one, were referred for US because of suspected inguinal hernia, hydrocele or inguinal mass. In one child, the US examination was performed to confirm the diagnosis of a spermatic cord hydrocele. An encysted hydrocele was diagnosed in 24 out of 27 cases, whereas a funicular type of spermatic cord hydrocele was found in the remaining 3 cases. Internal septa were seen within the fluid mass in four patients. 23 children underwent surgical exploration that confirmed the US diagnosis. Three children with encysted-type hydrocele were only followed clinically and by US, and one was lost from follow-up. US examination is a very sensitive and accurate method for diagnosis of this entity and for exclusion of other lesions in this region.
Hydrocele
Spermatic cord
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Spermatic cord
Spermatic Vein
Venography
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Objectives To investigate the nosogenesis of why varicosele can result in infertility.Methods The left spermatic and peripheral vein blood was taken from 50 infertility patients with varicocele and 40 normal cases,and the blood gas was mearsured.Results (1) The PH,PO2,SaO2,HCO3-of the left spermatic vein blood was lower than that of the peripheral vein blood from the male with varicocele (P ＜ 0.05),the PCO2,K + of the left spermatic vein blood was higher than that of the peripheral vein blood from the male with varicocele(P ＜0.05),but the other indexof them was not significant(P ＞ 0.05).(2) The PH,PO2,SaO2,HCO3-of the left spermatic vein blood from the male with varicocele was lower than that from the normal male(P ＜ 0.05),the PCO2,K + of the left spermatic vein blood from the male with varicocele was higher than that from the normal male(P ＜0.05),but the other index of them was not significant(P ＞ 0.05).(3)The density and motility rate of sperm fromthe male with 4 varicocele was lower than that from the normal male(P ＜ 0.05),and the abnormal rateof sperm from the male with varicocele was higher than that from the normal male (P ＜ 0.05).Conclusions The depression of the PH,PO2,SaO2,HCO3-and the rise of the PCO2,K + in the spermatic vein blood from the infertility patients with the varicocele may be the cause of the depression of the density and motility rate of sperm and the rise oftheabnormal rateof sperm which can result in infertility.
Key words:
Varicocele; Infertility, Male; Blood Gas Analysis
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The ACE is found as two isozymes in the body. A somatic isozyme found in blood and several other tissues, and a testis-specific isozyme found only in developing spermatids and mature sperm. In this study, we investigated the ACE activity in left spermatic vein blood samples of infertile patients with varicocele and its correlation to spermatologic parameters. The somatic ACE activities were determined in the peripheral and left spermatic vein blood samples from 31 infertile patients who underwent variococelectomy, and 11 fertile control subjects underwent left inguinal herniorraphy. The somatic ACE activity was measured by kinetic spectrophotometric assay. Semen analyses were performed according to WHO guidelines. The mean somatic ACE activities of peripheral and left spermatic veins of the varicocele group were 60.3 ± 23.0 and 60.2 ± 23.2 U/L, respectively. In control group, peripheral and left spermatic vein ACE activities were found as 56.8 ± 17.1 and 56.5 ± 15.5 U/L, respectively. There was no significant difference between the ACE activity in peripheral and left spermatic vein blood sample from the varicocele and control group. There was no statistically significant correlation between the spermatologic parameters and ACE activities in the spermatic and peripheral vein in both of varicocele and control groups. As a result, it may be suggested that the somatic ACE has no causative role in pathophysiology of varicocele and varicocele related infertility.
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Objectives To evaluate the effect of spermatic vein ligation in patients over 30 years old and with low‐grade left varicocele, and thus help to establish whether such patients might benefit from surgery. Patients and methods A randomized study was conducted on 68 infertile patients (30–38 years old) with evidence of sperm abnormalities and who had low‐grade varicocele (grade I according to Hirsch), comparing left spermatic vein ligation with no treatment. The outcome was assessed by standard sperm analysis and eventual paternity. Results There was no improvement in sperm quality in either of the groups one year after surgery, and no significant difference in paternity. Conclusions Left spermatic vein ligation for low‐grade varicocele in patients more than 30 years old cannot be recommended.
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