Challenging the Role of Cremasteric Reflux in the Pathogenesis of Varicocele Using a New Venographic Approach

Franco, Giorgio; Iori, F.; Dominicis, C. De; Forno, S. Dal; Mander, A; Laurenti, C

doi:10.1097/00005392-199901000-00039

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…Out of 232 patients, undergoing a pre‐operative CDUS evaluation, 197 (84.9%) patients had an internal spermatic vein (ISV) reflux (Coolsaet type I), 34 (14.6%) had both ISV and deferential vein (DV) reflux (Coolsaet type III); only 1 patient (0,5%) had isolated DV reflux (Coolsaet type II). According to literature (Franco et al. , 1999), no cases of cremasteric reflux were detected.…”

Section: Resultsmentioning

confidence: 99%

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Focus on paediatric and adolescent varicocoele: a single institution experience

et al. 2012

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The aim of this study was to report our long-term diagnostic and surgical outcome during the last 18 years, in paediatric and adolescent management of varicocoele. The present retrospective study enrols 374 patients observed at our institution between 1994 and 2011. Patients were divided into three groups: Group A includes 142 youngsters and adolescents treated with open surgery for left varicocoele, in which a pre-operative CDUS was not performed; Group B includes 65 patients treated with open surgery in which a pre-operative CDUS evaluation was carried out, to assess varicocoele haemodynamic pattern and testicular volume. Group C includes 167 patients treated by laparoscopy and with pre-operative CDUS assessment. For all groups post-operative follow-up consisted of CDUS evaluation performed 1, 3, 6, 12 months after surgical treatment, than every year. Persistence/recurrence of varicocoele, testicular volume and presence of hydrocele were evaluated. Recurrence rate was significatively higher in group A (11.2%) than B (no recurrence, p = 0.003) or C (no recurrence, p = 0.000). Post-operative hydrocele was not significantly observed overall in group A in 9.8% of cases (13% if tunica vaginalis was left untouched, 4.2% if everted or resected p = 0.005), in group B in 3% and in group C in 7.1% of cases (p = NS). In conclusion, open and laparoscopic surgery offers similar results. In our opinion, the key-point in paediatric and adolescent varicocoele is not the surgical approach to use, but the exact diagnosis. Careful CDUS evaluation is, in our opinion, a valid, safe, cost-effective and immediate tool to accurately detect all refluxing venous system and for achieving a comprehensive evaluation of the vascular anatomy of varicocoele in paediatric and adolescent age. Laparoscopic Palomo or open subinguinal microsurgical varicocelectomy offer similar results in terms of recurrence; meanwhile the use of a lymphatic sparing surgery with or without blue-dye is recommended to reduce post-operative hydroceles.

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Section: Resultsmentioning

confidence: 99%

“…In these cases the failure of first‐time surgery is because of the presence of refluxing venous system undetected at the time of first pre‐operative evaluation. The deferential refluxing vein (DV) is considered the main cause of varicocoele persistence/recurrence (Franco et al. , 1999; Esposito et al.…”

Section: Discussionmentioning

confidence: 99%

Focus on paediatric and adolescent varicocoele: a single institution experience

et al. 2012

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“…Moreover, varicoceles usually arose from the spermatic and sometimes the cremasteric veins [24]. Some researchers have argued that expanded deferential veins (diameter >3 mm) might also be implicated [25].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Approaches in Microsurgical Varicocelectomy in Chinese Infertile Males

Pan

Zhang

et al. 2013

Urol Int

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Objective: To compare the outcomes of two approaches (inguinal and subinguinal) of microsurgical varicocelectomy (MV) in Chinese infertile men. Patients and Methods: 120 infertile men who met the inclusion criteria were randomly assigned to two groups and operated with MV using different approaches. The outcomes and complications were then compared. Results: The two groups were similar in all aspects except the percentage of patients using analgesic at 27 h postoperatively (57.6% in the inguinal group, 37.5% in the subinguinal group; p < 0.05). Spontaneous pregnancy was achieved at a ratio of 33.9% in the inguinal group and 30.4% in subinguinal group. The median values of semen parameters were significantly improved postoperatively in both groups. Conclusions: Both approaches are effective methods in the repair of varicocele in infertile men, but more analgesic medication at the first day after operation may be required in inguinal group.

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“…There were no Coolsaet type-2 varicoceles resulting from an isolated iliac-deferential reflux. Moreover, according to the venographic studies of Franco et al [22], who challenged the existence of cremasteric vein reflux, we did not investigate the presence of this component of the varicocele.…”

Section: Discussionmentioning

confidence: 99%

The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents

et al. 2006

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In a study from Italy, colour‐Doppler ultrasonography was a reliable diagnostic tool in the preoperative assessment of patients with varicocele. The authors also found that it helped to distinguish those who could be treated laparoscopically from those who should be treated by microsurgical subinguinal ligature. OBJECTIVE To investigate whether colour Doppler ultrasonography (CDUS) is a reliable diagnostic tool for selecting patients with varicocele to undergo either laparoscopy or open microsurgical subinguinal ligation. PATIENTS AND METHODS In a 3‐year period, 42 boys affected by left varicocele were evaluated before surgery by inguinal and scrotal CDUS. Using this method it was possible to distinguish Coolsaet type‐1 varicocele (due to isolated renal‐internal spermatic vein reflux) and Coolsaet type‐3 varicocele (due to associated renal‐internal spermatic reflux and iliac‐deferential reflux). Boys with Coolsaet type‐1 varicocele were treated by a laparoscopic transperitoneal Palomo procedure, whereas those with Coolsaet type‐3 varicoceles were treated by lymphatic‐sparing microsurgical subinguinal ligation. RESULTS The varicocele was Coolsaet type‐3 in six patients (14%), who had microsurgical open surgery, and the remaining 36 (86%) had Coolsaet type‐1 and had laparoscopic surgery. At the follow‐up there was no venous scrotal reflux. In two patients in the laparoscopic group a hydrocele developed after surgery, which resolved spontaneously. CONCLUSIONS This study showed that CDUS was a reliable diagnostic tool for assessing boys with varicocele. It clearly distinguished Coolsaet‐type 1 varicoceles that can be treated laparoscopically, from Coolsaet type‐3 varicoceles that should be treated with microsurgical subinguinal ligature.

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Challenging the Role of Cremasteric Reflux in the Pathogenesis of Varicocele Using a New Venographic Approach

Cited by 7 publications

References 15 publications

Focus on paediatric and adolescent varicocoele: a single institution experience

Focus on paediatric and adolescent varicocoele: a single institution experience

Comparison of Two Approaches in Microsurgical Varicocelectomy in Chinese Infertile Males

The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents

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