Editorial Comment to Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele (original) (raw)
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A comparison between the efficacy and safety of microscopic inguinal and subinguinal varicocelectomy
Türk Üroloji Dergisi/Turkish Journal of Urology
Objective: To compare microscopic inguinal (MIV) and subinguinal varicocelectomy (MSV) surgeries with respect to efficacy and safety. Material and methods: Patients who underwent varicocelectomy between January 2002 and January 2018 were evaluated retrospectively and prospectively. The patients who underwent varicocelectomy until December 2015 were analyzed retrospectively and the cases after January 2016 were analyzed prospectively. In our study, the married infertile male cases were compared on the basis of operation duration, number of ligated veins, number of preserved veins, postoperative pain score (visual analogue scale: VAS), patient satisfaction, surgeon satisfaction, changes in sperm parameters, testicular consistency, pregnancy rates, and complications, such as hydrocele, testicular atrophy, and recurrence of varicocele. Surgical success rates were compared by semen analysis between unmarried infertile male cases because pregnancy rates cannot be tested. The patients were recalled for control examinations every 3 months for 1 year and tested the above-mentioned parameters. Statistical Package for the Social Sciences Version 20 Windows Software was used for data analysis and comparison between the two groups. Results: The study included a total of 136 adult patients. Mean age of the patients was 28.14 (20-41) years. MSV and MIV were performed in 62 (45.6%) and 74 (54.4%) patients, respectively. No statistically significant difference was detected between the two groups in terms of admission duration, semen parameters within the 1-year follow-up process, hormonal changes, and complication rates. Operation duration was significantly longer in the MSV group. It was determined that a fewer number of veins were ligated, and a fewer number of veins needed to be ligated in the MIV group. The analysis of all the patients revealed that pain scores at 4 and 24 hours postoperatively were significantly statistically lower in the MSV group. Conclusion: MIV and MSV are distinct, efficient, and safe surgical techniques with specific advantages and disadvantages. Their efficacy and safety rates are similar.
Incidence of external spermatic veins in patients undergoing inguinal varicocelectomy
Urology, 1994
To determine the incidence of external spermatic veins at inguinal varicocelectomy. A prospective study was performed by making intraoperative observations on 78 varicocelectomies (47 patients) performed by a single surgeon. All patients were referred for evaluation of male infertility and had a palpable varicocele present when examined while performing a Valsalva maneuver in the upright position. Varicocelectomies were performed via the inguinal approach using x 2.5 loupe magnification. Presence of external spermatic veins was defined as visualization (with x 2.5 loupe magnification) of veins on the floor of the inguinal canal traveling posterolateral to the spermatic cord that then subsequently exited the spermatic cord before passing through the internal inguinal ring. Age, anesthetic technique, and need for incision of the external inguinal ring were also recorded for each patient. One third of patients had undergone left-sided varicocelectomies, while two thirds had undergone b...
A New Microsurgical Technique for Varicocele Correction
Journal of Andrology, 1984
Varicocele is the consequence of a hemodynamic abnormality causing venous hypertension and consequent dilatation of the spermatic veins. In many cases, the correction of varicocele has led to improvement in semen quality. Conventional techniques of varicocele correction have the sole aim of occluding a nonfunctioning venous pathway, but do not attempt restoration of a hemodynamically correct venous drainage of the testis. We propose a new microsurgical technique for varicocele correction that achieves anastomosis between the spermatic vein and the epigastric vein. Either stump of the epigastric vein can be used, depending on the type of varicocele. In this way, a hemodynamically correct surgical solution can be achieved.
Microsurgery and varicocele: State of the art
Microsurgery, 1998
Many surgical procedures have been proposed in the treatment of varicocele; however, the rate of recurrence and of postoperative complications, together with important correlation of this disease with male sterility, has played an important role in determining the success of microsurgery. In the present brief review, the indications for microsurgery and microsurgical dissection and/or anastomosis are described in comparison to traditional surgery.
Asian Journal of Andrology, 2012
The microanatomy of the inguinal spermatic cords has never been reported in Asia. The purpose of this study was to describe the number and relationship of the veins, arteries and lymphatics in the spermatic cord and to clarify the location of the vas deferens in Asian men. Fifty-one patients receiving 79 primary microsurgical varicocelectomies performed by a single surgeon from April 2011 to July 2012 were studied. The number of internal and external spermatic veins, testicular arteries and lymphatic channels preserved during the inguinal microsurgical varicocelectomy were recorded. The relationship between the right and left vascular anatomy during bilateral varicocelectomies was evaluated. The data showed that mean numbers of 1.560.9 arteries, 5.662.2 spermatic veins and 3.661.9 lymphatics were identified during the repairs. The internal spermatic arteries were surrounded by a dense complex of adherent veins in 81.2% of the cases. The external spermatic vein or veins were found in 60.8% of the cases. The vas deferens may be contained within the internal spermatic fascia. The results suggest that the number of veins may be highly variable and less than those reported in the English literature, but there is some similarity in the inguinal microanatomy of the right and left spermatic cords. Further research is warranted to clarify our results.
Effect of Scrotal Veins Ligation on Varicocele Grade and Duplex Parameters
Al-Azhar Medical Journal, 2015
Background: Varicocele is approached by various interventional techniques, none of which is yet considered the best. Some are relatively expensive, time-consuming and require special skills and training especially microsurgical techniques. Objectives: Evaluation of scrotal veins contribution to varicocele and the effect of its ligation on postoperative varicocele grade and Duplex parameters. Patients and methods: Sixty patients with clinically and sonographically detectable varicocele grades II and III, abnormal semen, a preoperative diameter of veins of more than three millimeters, and time of regurge more than one second through Valsalva's maneuver, together with dilated and regurging scrotal veins, were randomly divided into 2 equal groups: Group I were treated by subinguinal varicocelectomy only, and Group II were treated by subinguinal varicocelectomy with additional scrotal veins ligation. Results: Both surgical techniques showed significant improvements in clinical grades of varicocele and Duplex parameters (diameter of veins and time of venous reflux). However, the postoperative improvement in time of venous reflux was significantly higher in group II. Recurrence and complications were comparable with no significant difference between both groups. Conclusion: The improvement in clinical grades of varicocele and Duplex parameters was insignificant in both surgical techniques. Improvement in time of venous reflux was significantly higher in patients treated by subinguinal varicocelectomy with additional scrotal veins ligation.
European Urology, 2002
Objectives: To introduce a useful technique for identifying any collateral veins during laparoscopic varicocele operation and to evaluate our long-term results with this technique after 100 cases. Methods: A new method was used to detect an incidental collateral vein. During surgery the patient was placed in anti-Trendelenburg position after introducing laparoscopic instruments until the dilated scrotal varicose ®lled up with blood. The main spermatic vein was then grasped atraumatically and the blood was pressed out manually from the scrotum. During this manoeuvre any existing collateral vein/veins became dilated and could be easily identi®ed. The dilated spermatic vein and also any collateral vessel were ®rst prepared then clipped. Results: Out of the 100 patients, collateral veins were detected and ligated in 19 cases. In 15 cases a single collateral, in 4 cases two collaterals, and in the remaining 81 children no collateral veins were found. The testicular artery was identi®ed in all operations as a pulsatile vessel. At a mean of 24 months (range 6±60 months) follow-up recurrence occurred in one patient and in ®ve children hydrocele developed postoperatively. Testicular atrophy and severe intraor postoperative complication did not occur in any patient of this series. Conclusion: The identi®cation of incidental collateral vein by this method and preservation of the testicular artery resulted in a very good success rate in children and adolescents treated by laparoscopic varicocele operation. #