A New Entity in Varicocele Subfertility: The “Cremasteric Reflux”

Sayfan, Joel; Adam, Y; Soffer, Y.

doi:10.1016/s0015-0282(16)44486-9

Cited by 48 publications

(23 citation statements)

References 3 publications

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“…Less commonly, failure is due to the presence of parallel inguinal or retroperitoneal collaterals that may exit the testis, bypass the retroperitoneal area and join the internal spermatic vein proximal to the site of ligation (65,66). Cremasteric veins cannot be identified using a retroperitoneal approach and may be a potential site of varicocele recurrence (67). The recurrence rate after balloon occlusion varies from 4% to 11% (62,65,68,69).…”

Section: Complications Of Varicocele Repairmentioning

confidence: 99%

Varicocele: Evaluation and treatment

Zini¹

2002

J Sex Reprod Med

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Varicocele is the most common identifiable pathology in infertile men. It is present in 15% of the male population, in approximately 35% of men with primary infertility and in 50% to 80% of men with secondary infertility. It is generally accepted that varicocele exerts a negative influence on spermatogenesis and steroidogenesis, primarily by elevating testicular temperature. However, the effect of varicocelectomy on the restoration of testicular function and fertility in adults is the subject of ongoing controversy. Microsurgical varicocelectomy has been advocated as the 'gold standard' method, based on the low complication rate associated with this procedure. In the era of advanced assisted reproduction, varicocelectomy is a valuable tool in the management of infertile men. Key Words: Assisted reproduction; Male infertility; Spermatogenesis; Varicocele; VaricocelectomyVaricocèle : Évaluation et traitement RÉSUMÉ : La varicocèle est la pathologie identifiable la plus répandue chez les hommes infertiles. Elle s'observe chez 15 % de la population masculine, chez environ 35 % des hommes ayant un problème d'infertilité primaire et chez 50 à 80 % des hommes ayant une infertilité secondaire. On s'entend en général pour dire que la varicocèle exerce une influence négative sur la spermatogenèse et sur la stéroïdogenèse, principalement par le biais d'une élévation de la température des testicules. Par contre, l'effet de l'ablation de la varicocèle sur le rétablissement de la fonction testiculaire et de la fertilité chez les adultes fait toujours l'objet d'une controverse. L'ablation de la varicocèle par microchirurgie a été proposée comme méthode standard sur la base du faible taux de complications qui lui est associé. À l'ère des technologies de reproduction de pointe, l'ablation de la varicocèle est un outil utile pour le traitement des hommes infertiles. V aricocele is defined as dilated testicular veins in the scrotum, and is the most common identifiable pathology in infertile men. Although it is accepted that varicocele exerts a negative influence on male fertility potential, the effect of varicocelectomy on the restoration of fertility in men is the subject of ongoing controversy. The present article is not intended to resolve controversial issues regarding varicocele, but rather should provide the reader with a basic overview of the subject, with emphasis on the pathophysiology, diagnosis and treatment of this condition. INCIDENCEThe incidence of varicocele in the general male population is approximately 15% (1-4). The incidence in men presenting for infertility is about 35%, and in men with secondary infertility it is 50% to 80% (5-7). Although varicocele is almost always larger and more common on the left side (5,8), the incidence of bilateral varicocele is approximately 50%. The rare, isolated, right-sided varicocele generally suggests that the right internal spermatic vein enters the right renal vein, but it should prompt further investigation because this finding may be associated with situs inversus or retro...

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Section: Complications Of Varicocele Repairmentioning

confidence: 99%

Varicocele: Evaluation and treatment

Zini¹

2002

J Sex Reprod Med

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“…Say fan et al [15,16] by using intraoperative phlebogra phy, were able to show a dilated tortuous external sper matic vein in 3 o f 25 patients (12%).…”

Section: Discussionmentioning

confidence: 97%

Extended Vein Ligation: A New Aspect of the Surgical Treatment of Varicocele

Albayrak¹,

Can²,

Sarıca³

1993

Urol Int

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Conventional varicocelectomy is complicated by a postoperative recurrence rate of 5–20% in patients with varicocele [1, 2]. On the other hand, the exact location and relationship of the internal, external and gubernacular veins, arteries and lymphatics within the inguinoscrotal portion of the spermatic cord have not been well described. The results of detailed intraoperative observations and surgical dissection of the spermatic cord and gubernaculum are presented in 32 patients with clinically palpable varicocele. Following the identification of all veins within and around the spermatic cord and gubernaculum, dilated veins originating from the testis and traversing the gubernaculum were observed in 31 % of the patients. External spermatic veins were present in 70% of all spermatic cords evaluated. The majority of patients ( > 65%) had more than 3 internal spermatic veins. An average of 3.1 lymphathics per spermatic cord was identified and preserved during dissection of the cord. A solitary testicular artery was observed in 55% of the patients treated. In 3 patients with recurrent varicocele, by using intraoperative venography, we tried to demonstrate the relationship between the gubernacular, external spermatic veins and the plexus pampiniformis. Our results indicate that by giving a precise attention to varicocele anatomy and performing an extended vein ligation, better results together with decreased recurrence rates may be obtained.

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“…The damage to the basement membrane seems to be time-dependent, as shown by ultrastructural and immunohistochemical observations that highlighted focal damage at the level of the peritubular basal lamina in pubertal boys with varicocele, but this damage was not as severe as that described in adult varicocele [32]. Sayfan et al in their study have shown that testicular volume fails to either increase or actually decrease in size of testis that is associated with varicoceles [33]. The loss of testicular volume in the presence of varicocele is related to the loss of seminiferous tubule elements and decrease in tubular diameter, which may lead to higher incidence of subfertility and abnormal seminal parameters.…”

Section: Histopathologymentioning

confidence: 90%

“…Right testicular volume improved more than left testicular volume to a statistically significant degree after varicocelectomy. Explanation for the improved rightsided testicular volume after left varicocelectomy may be due to the crossover of venous circulation between left and right sides [33]. It should be noted, however, that catchup testicular growth among adolescents following varicocele repair is not universal and may be dependent on several factors including patients age [22].…”

Section: Histopathologymentioning

confidence: 99%

Outcome of Varicocelectomy with Different Degrees of Clinical Varicocele in Infertile Male

Reddy

Shaik

Surayapalem

et al. 2015

Advances in Andrology

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Aim. To evaluate the prevalence and effect of varicocele repair on sperm motility, sperm concentration, testicular volume, and pregnancy rate in different degrees of clinical varicocele. Material and Methods. The case records were retrospectively evaluated for 482 infertile patients with varicocele who underwent varicocelectomy from December 2008 to December 2013. Semen analysis of patient at preoperative and 3-, 6-, and 12-month postoperative period was done. Varicocele was graded as per the World Health Organization grading (WHO 1993) system and included in the study. Testicular volume was noted by ultrasonography in pre-and postoperative period in one-year follow-up. Pregnancy rate was calculated at 3, 6, and 12 months of follow-up. Results. Significant differences were seen in sperm motility and concentration of patients with Grade 3 varicocele as compared with Grade 1 and Grade 2 varicocele. Significant increase in testicular volume was present after one year in Grade 3 varicocele in the postoperative period. There was significant correlation between the testicular volume and the sperm concentration. Percentage of spontaneous pregnancy in 1 year after varicocele treatment was 32 to 41% of cases. Conclusion. Varicocelectomy significantly improved sperm motility, concentration, and testicular volume. There were 32 to 41% of infertile patients who achieved pregnancy spontaneously.

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A New Entity in Varicocele Subfertility: The “Cremasteric Reflux”

Cited by 48 publications

References 3 publications

Varicocele: Evaluation and treatment

Varicocele: Evaluation and treatment

Extended Vein Ligation: A New Aspect of the Surgical Treatment of Varicocele

Outcome of Varicocelectomy with Different Degrees of Clinical Varicocele in Infertile Male

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