Microsurgical bypass for varicocele with nutcracker syndrome / 中华男科学杂志

Objective@#To investigate the clinical effect and feasibility of internal spermatic vein-inferior epigastric vein (ISV-IEV) bypass surgery in the treatment of varicocele complicated by left renal vein nutcracker syndrome (NCS).@*METHODS@#We retrospectively analyzed the clinical data about 30 cases of varicocele with left renal vein NCS treated by ISV-IEV bypass surgery in our hospital from June 2014 to February 2017. We reviewed the follow-up data and results of ultrasonography, routine urianlysis and semen routine examination.@*RESULTS@#All the operations were successfully accomplished and postoperative color Doppler ultrasonography showed that varicocele was cured in all the cases. At 6 months after surgery, sperm concentration and the percentage of grade a+b sperm were significantly improved (［34.47 ± 8.60］ ×10⁶/ml and ［63.54% ± 9.58］ %) as compared with the baseline (［19.90 ± 8.97］ ×10⁶/ml and ［37.93 ± 8.73］ %) (P <0.05). Hematuria was cured in 23 and alleviated in 1 of the 24 cases. Proteinuria disappeared in all the 14 cases, with neither scrotal pain symptoms nor obvious complications.@*CONCLUSIONS@#ISV-IEV bypass surgery, with its advantages of safety, effectiveness, minimal invasiveness, and simple operation, deserves wide clinical application in the treatment of varicocele with left renal vein NCS.

Hydrodynamic Relationship between Color Doppler Ultrasonography Findings and the Number of Internal Spermatic Veins in Varicoceles

PURPOSE: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. RESULTS: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. CONCLUSION: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.

Blood Gas Analysis of the Spermatic Vein and Antecubital Vein in the Patients with Bilateral Varicocele / 대한비뇨기과학회지

Varicocele remains an important correctable cause of infertility. There are many theories of the mechanism about the cause of infertility, yet pathophysiology remains poorly understood. Several investigators have found no alterations in oxygen or carbon dioxide pressures in spermatic venous blood in varicocele patients. We checked blood gas of the left, right internal spermatic vein, and antecubital vein of 21 patients with clinical varicocele. The mean of carbon dioxide pressure in the left (43.5mmHg) and the right (44.3mmHg) internal spermatic vein was not higher than antecubital vein (47.8mmHg) (p<0.05). The mean oxygen pressure in the left internal spermatic vein (60.5 mmHg) was not lower than antecubital vein (42.5mmHg)and the mean oxygen pressure in the left internal spermatic vein was higher than right internal spermatic vein (50.9 mmHg). Both Leydig cell and germinal cell dysfunction caused by testicular hypoxia secondary to venous stasis and small-vessel occlusion must be reestablished.

Percutaneous Embolization of the Internal Spermatic Vein for Treatment of Varicocele: 4 Cases / 대한비뇨기과학회지

Percutaneous embolization of the internal spermatic vein under the phlebography is a new alternative method in the treatment of idiopathic varicocele. Embolization with the stainless steel coil was attempted in 4 cases of varicocele which showed passive reflux from the left renal vein to the internal spermatic vein on the phlebography. 3 cases were corrected by the percutaneous embolization successfully and no dislocation of the coil was observed on the follow-up films. In failure case, the renal catheter could not be engaged into the internal spermatic vein.

A Study of Internal Spermatic Vein Cortisol in Patients with Varicocele / 대한비뇨기과학회지

Although it is generally accepted that varicocele is a major cause of male infertility, the mechanism by which varicocele exerts its deleterious effect on spermatogenesis still remains obscure. So, to elucidate the cause of infertility that is the result of varicocele, cortisol levels in the internal spermatic vein blood samples were compared with those of the peripheral vein blood samples from 20 patients with varicocele. In 14 of the 20 patients, cortisol levels were found to be lower in the internal spermatic vein blood than in the peripheral vein blood. In the other 6 patients, cortisol levels were higher in the internal spermatic vein blood. However, no significant differences were observed between the concentrations in the internal spermatic vein (13.12+/-12.12 microgram/dl) and those in the peripheral vein (13.89+/-9.94 microgram/dl) of all cases. Therefore it seems unlikely that testicular dysfunction in patients with varicocele is caused by reflux of adrenal venous blood with toxic metabolites into the internal spermatic vein.

A Study of Internal Spermatic Vein Cortisol in Patients with Varicocele / 대한비뇨기과학회지

Although it is generally accepted that varicocele is a major cause of male infertility, the mechanism by which varicocele exerts its deleterious effect on spermatogenesis still remains obscure. So, to elucidate the cause of infertility that is the result of varicocele, cortisol levels in the internal spermatic vein blood samples were compared with those of the peripheral vein blood samples from 20 patients with varicocele. In 14 of the 20 patients, cortisol levels were found to be lower in the internal spermatic vein blood than in the peripheral vein blood. In the other 6 patients, cortisol levels were higher in the internal spermatic vein blood. However, no significant differences were observed between the concentrations in the internal spermatic vein (13.12+/-12.12 microgram/dl) and those in the peripheral vein (13.89+/-9.94 microgram/dl) of all cases. Therefore it seems unlikely that testicular dysfunction in patients with varicocele is caused by reflux of adrenal venous blood with toxic metabolites into the internal spermatic vein.

Clinical Evaluation of Intraoperative Phlebography of Internal Spermatic Vein in Varicocele / 대한비뇨기과학회지

Intraoperative internal spermatic vein phlebography was performed in 12 primary and 3 recurrent cases of varicocele. The following results were obtained. 1. Marked dilation of the left internal spermatic vein was observed in 13 cases (87%), and retrograde flow was seen in 7 cases (47%). 2. Double or triple left internal spermatic vein was seen in 8 cases (53%). 3. Cross collateral venous circulation was noted in 6 cases (40%). 4. Intraoperative internal spermatic vein phlebography enabled to us understand the venous anatomy and the etiology of primary and recurrent varicoceles, and was an aid for the surgical removal of varicocele.