The history of varicocele: from antiquity to the modern ERA

ABSTRACT Men have most likely been affected by varicocele since the assumption of the upright position. In De Medicina, written during the first century AD, Celsus credits the Greeks with the first description of a varicocele, and he recorded his own acute observation: "The veins are swollen and twisted over the testicle, which becomes smaller". Celsus himself is credited with the distinction between varicocele (dilation of surface veins) and "cirsocele" (dilation of deep veins). There has been a long history of treatment attempts and failures, some of which are remarkably strange, that have sometimes cul- minated in tragedy, as in the case of French professor Jacques-Mathieu Delpech (1772-1832). Although some questions regarding the etiopathology and treatment of varico- cele remain unanswered, a succession of more or less conservative attempts involving all medical cultures has been performed throughout history. The report by W.S. Tulloch in 1952 brought varicocele into the era of modern evidence-based medicine, and varicocele surgery finally progressed beyond the aim of merely relieving scrotal pain and swelling. From 1970 to 2000, varicocelectomies gained worldwide attention for the treatment of male infertility. Several innovative procedures to correct varicoceles began to appear in the world's literature as interventional radiology, microsurgery, laparoscopy, and robotics, while comprehensive review articles were also published on the subject of varicocelectomies. Microsurgery is nowadays used worldwide and it can be considered to be the gold standard for correcting infertility linked to varicocele.

Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion

ABSTRACT Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) Main Etiologic (testicular torsion) Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

Transcatheter Embolization of a Ruptured Internal Pudendal Artery Pseudoaneurysm in a Patient with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder. Pseudoaneurysms formation and rupture is an unusual complication of neurofibromatosis. To date, pseudoaneurysm of the internal pudendal artery associated with NF-1 has not been reported. In this article, we present a 62-yr-old man with NF-1 suffering from spontaneous hematoma of the perinea and scrotum. A digital substraction angiography disclosed a ruptured pseudoaneurysm of the right internal pudendal artery, which was successfully managed with transcatheter embolization.

Clinical application of scrotal flap on penis lengthening

To investigate the clinical application of the scrotal flap on penis lengthening. One hundred and fifty-two patients were operated using the scrotal flap from July 1998 to January 2008 at the Department of Plastic and Aesthetic, Surgery Southwest Hospital, Chongqing, China. The procedure consisted of designing a positive sign shaped incision 1.5cm above the root of the penis, dissect and release the superficial suspensory ligament and part of the deep suspensory ligament, then cover the elongated cavernosum with proper scrotal flap. Six-month to 5-year follow-up showed that all patients were satisfied with the good contour and function of the penis. The operation was successful. The method of using scrotal flap on penis lengthening has the following advantages: simple operation, reliable blood supply of the flap, one-stage operation, and satisfactory postoperative results. It is a preferable operation technique for penis lengthening

Bleeding scrotal varices as presentation of Budd-Chiari syndrome.

Budd-Chiari syndrome presents with ascites, edema and bleeding from esophageal varices. Presentation as bleeding scrotal varices is rare. We report a patient with Budd-Chiari syndrome who presented with recurrent bleeding from scrotal varices for 20 years.

Dopplersonografia do escroto / Collor doppler sonography of the scrotum

A ultra-sonografia associada ao doppler colorido é importante meio para a avaliaçäo do escroto, principalmente no que se refere a patologias agudas. A utilizaçäo do doppler colorido permite boa avaliaçäo do suprimento arterial do cordäo espermático e testículos. Nas doenças inflamatórias do escroto há uma hipervascularizaçäo intratesticular. Porém, o principal uso do doppler colorido se faz na diferenciaçäo das desordens inflamatórias com relaçäo à torçäo, na qual prevalece o quadro de dor aguda. No caso de torçäo haverá ausência ou diminuiçäo acentuada do fluxo arterial intratesticular. Em casos de varicocele haverá captaçäo espectral de fluxo venoso de forma ativa à manobra de Valsalva ou passivamente no interior de vasos escrotais maiores que 0,3 cm. Por último, os tumores pequenos (<1,6 cm) tendem a ser hipovascularizados e os tumores maiores (>1,6 cm), hipervascularizados

Irrigaçäo arterial do escroto de zebu, Bos indicus / The arterial supply to the scrotum of the zebu, Bos indicus

Foram estudados a distribuiçäo e o comportamento das artérias que participam da irrigaçäo do escroto e dos outros envoltórios testiculares do zebu. De acordo com a origem e posiçäo topográfica destes vasos propöe-se agrupá-los em sistemas arteriais superficial e profundo

Cintigrama escroto-testicular: metodología y estado actual / Methodology and present state of scrotum and testicular scintigraphy

Se presentan los aspectos metodológicos y los resultados clínicos del cintigrama escroto-testicular en la evaluación de una población masculina portadora de varicocele. El examen consiste fundamentalmente en el estudio de la vascularización arterial y del drenaje venoso del escroto y de su contenido, mediante la inyección endovenosa de Tecnecio 99 cm con el objeto de marcar in vivo los glóbulos rojos del mismo paciente. En su primer paso evalúa los vasos arteriales ilio-femorales y escroto-testiculares y mediante imágenes tardías, los troncos venosos profundos y el sistema de drenaje testicular o plexo pampiniforme. El cintigrama escroto-testicular encuentra sus principales indicaciones en el diagnóstico diferencial rápido, confiable y no invasivo del testículo agudo, separando los cuadros de resolución quirúrgica (torsión) de aquellos de tratamiento médico (procesos inflamatorios) y en la evaluación del varicocele, ya sea como causa de dolor testicular o de subfertilidad o en el control de su tratamiento. Nuestros resultados en un grupo de 54 pacientes con varicocele clínico o subclínico, dan una sensibilidad global del 65%, algo más baja que la publicada en otras series. Con metodología depurada y con criterios precisos de interpretación, el cintigrama escroto-testicular debería incorporarse al arsenal diagnóstico del internista y del urólogo. El examen no tiene contraindicaciones formales y la dosis de radiación absorbida por el paciente es muy baja, del orden de 0.40 Rads/examen en lo que respecta a las gónodas