Comparison of Recurrent Varicocele Anatomy Following Surgery and Percutaneous Balloon Occlusion

Murray, Robert; Mitchell, Sally E.; Kadir, Saadoon; Kaufman, Stephen L.; Chang, Richard; Kinnison, M L; Smyth, Joanna; White, Robert I.

doi:10.1016/s0022-5347(17)45615-1

Cited by 104 publications

(67 citation statements)

References 13 publications

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“…Failure is Zini usually due to the preservation of the periarterial plexus of fine veins (venae commitantes). 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).…”

Section: Complications Of Varicocele Repairmentioning

confidence: 99%

“…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). The microsurgical approach with delivery of the testis lowers the incidence of varicocele recurrence to less than 1% (46).…”

Section: Complications Of Varicocele Repairmentioning

confidence: 99%

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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%

Section: Complications Of Varicocele Repairmentioning

confidence: 99%

Varicocele: Evaluation and treatment

Zini¹

2002

J Sex Reprod Med

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“…[40][41][42][43][44] The microsurgical varicocelectomy is considered the "gold standard" because it is associated with the lowest risk of complications (varicocele recurrence, hydrocele formation [fluid collection around the testicle] and testicular atrophy). 41,[45][46][47] We have favoured the microsurgical subinguinal approach because it is associated with a higher success rate (disappearance of varicocele) and a lower complication rate (recurrence rate and hydrocele formation), compared with nonmicrosurgical techniques. 46,48 The subinguinal approach is also associated with less operative and postoperative pain than inguinal approaches.…”

Section: Varicocelectomy: Approachesmentioning

confidence: 99%

Varicocelectomy: microsurgical subinguinal versus inguinal technique

Zini

Binsaleh²,

Lo³

2012

CUAJ

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273POINT / COUNTERPOINT I t is reported that 35% to 40% of infertile men have a palpable varicocele (dilated testicular veins), whereas the prevalence of a varicocele in the general male population is about 15%.1-3 Although varicoceles have been associated with impaired male fertility potential, it is also clear that a significant proportion of men with a varicocele (about 75%) are fertile. 2,4,5 As such, a cause and effect relationship between varicocele and male infertility has not been conclusively established. 6 The effect of varicocelectomy on male fertility is also controversial.6-10 Uncontrolled studies have generally shown improved semen quality and pregnancy outcome after surgery.11 On the other hand, the results of randomized controlled studies of varicocelectomy for clinical varicocele (only a few such studies are published) are equivocal. [12][13][14][15] Despite the absence of clear evidence for a positive effect of varicocelectomy, many clinicians consider the data sufficient to support the practice of this surgery, and varicocele is the most commonly treated condition in men with infertility in North America. 8 The benefit of varicocele repair must be balanced by the risk associated with the procedure itself. As such, it is important to select the procedure with the highest success and lowest complication rate. Also, it is important to consider assisted reproductive technologies (ARTs) as an alternative to varicocelectomy in infertile couples. 16 Etiology of varicoceleThe etiology of varicocele is multifactorial. The anatomic differences between the left and right internal spermatic vein (accounting for the predominance of left-sided varicocele), the incompetence of venous valves resulting in reflux of venous blood and increased hydrostatic pressure are the most popular theories. 17,18 Increased intraabdominal pressure during childhood and early adolescence may be a predisposing factor in the development of a varicocele. 19 Mechanisms of varicocele-induced pathologyScrotal and intratesticular temperatures are elevated in humans and in experimental animal models with varicocele, and varicocelectomy may reduce testicular temperature. [20][21][22][23][24] Scrotal hyperthermia likely represents the primary factor by which a varicocele affects endocrine function and spermatogenesis, both sensitive to temperature elevation (testicular proteins exhibit a reduced thermal stability compared with proteins from other organs). [25][26][27] The detrimental effect of hyperthermia may also be exerted on the epididymis. 28 Experimental elevations in epididymal temperature reduce the storage capacity of this organ, resulting in decreased sperm count and quality in the ejaculate. 28Increased hydrostatic pressure in the internal spermatic vein from renal vein reflux may also be responsible for varicocele-induced pathology. Pathophysiology of varicoceleThe adverse effect of varicocele on male fertility is most clearly manifested by the testicular atrophy generally associated with this condition. 4 Using scrota...

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“…However, these techniques have a recurrence rate that ranges from 5 to 45% [6, 7]. These recurrences are usually the result of residual venous communications from mid retroperitoneal or low inguinal parallel collaterals [8, 9]. Radiologic embolization techniques are also associated with high recurrence rates ranging from 2 to 64% [10].…”

Section: Introductionmentioning

confidence: 99%

“…Although physical examination is most commonly used to detect the presence of a clinical varicocele [1, 13], methods using radiologically documented recurrence after varicocele repair are still controversial [14]. Some authors have reported that selective internal spermatic venography (SISV) is helpful to document varicocele recurrence [8, 9, 14, 15]. …”

Section: Introductionmentioning

confidence: 99%