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

Albayrak, Selami; Can, Cavit; Sarıca, Kemal

doi:10.1159/000282548

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Varicocele has been shown to have extremely low recurrence rate (0.5 %) together with the elimination of postoperative hydrocele formation (0 %) in 456 cases operating with sequential microsurgical varicocelectomies (5). Other authors recommend a routine inspection and ligation of all external spermatic veins to eliminate the residual venous communications which are often responsible for surgical failure; together with, an internal spermatic vein ligation under optic magnification in order not to miss small veins that could result in recurrence must be treated (3). In patients with congenital bilateral absence of the vas deferens (CBAVD) presenting for varicocele the standard microsurgical varicocelectomy with ligation of all internal and external spermatic veins can be performed without the risk of testicular congestion secondary to inadequate venous drainage (21).…”

Section: Introduction Varicocelementioning

confidence: 99%

Valves of the gonadal veins

Heinz¹,

Brenner²

2010

Phlebologie

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Summary Purpose: Varicocele seems not to rely on the number of valves within the pampiniform plexus, the initial failure might be located on a higher level. Therefore, the failure should also occur in females. There is a comparable disease, Pelvic congestion syndrome, as result of pelvic venous engorgement due to gross dilatation and incompetence of ovarian veins.Thus, we need a detailed description of venous course, branching as well as frequencies and locations of valves within both genders. Page 3/23 Material and Methods: In 31 Caucasian formalin-fixed bodies (15 males, 16 females) we investigated course and valves from Ovaries or internal inguinal ring, respectively, up to termination into inferior vena cava or left renal vein, respectively. Specimens were documented photographically and by a distinct protocol. Results: In general, we found one valve on each side (testicular vein right 41.93%, left 51.52%; ovarian vein right 51.61%, left 45.45%). Two specimens had two valves per vein, each in a left testicular vein, and 15 veins showed absent valves. Valves existed between 0.0–4.5 cm, mainly 0.0–1.0 cm. One corpse showed varicose ovarian veins. Conclusion: If veins show varices, one would expect missing valves or insufficient function. In contrast, none of our 15 valve-less veins showed varices or even enlargement. Also surprising, the only case with varices had one valve on each side. The terminal segment in both genders was almost identical and the venous course was similar. Precisely: men frequently had (N=11) less valves then women (N=4).

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Section: Introduction Varicocelementioning

confidence: 99%

Valves of the gonadal veins

Heinz¹,

Brenner²

2010

Phlebologie

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“…Conventional techniques are associated with substantial risks of complications such as hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The postoperative recurrence rate in conventional techniques may reach up to 20% of patients with varicocele ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: outcome analysis

Mohd Hashim,

Fam,

Azizi

et al. 2024

Transl Androl Urol

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Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The advantages of the microscopic approach to varicocele repairs are detailed identification and preservation of the vascular structures. In this study, our purpose is to review the outcome of all patients that underwent microscopic subinguinal varicocelectomy with the video telescopic operating microscope (VITOM). Hence, a retrospective review of 23 varicocele patients who underwent microscopic subinguinal varicocelectomy at the center from the year 2019 until 2021 was done. They, ranging between 18 to 58 years of age, comprising one case of right varicocele, fifteen cases of left varicocele, and seven cases of bilateral varicocele, were all having symptoms (pain and swelling) and clinically palpable varicocele. Ultrasounds were done to confirm the diagnosis and measure the testicular size. The surgery was performed by a single surgeon, under spinal anesthesia. The operation was performed using the VITOM telescope system, with an average operative time of one hour. The patients were followed-up at one month postoperatively to review the wound and symptoms. Phone call evaluations of all 23 patients were done to detect any recurrence or complications. All patients were discharged one day after surgery. Post-operative, all of them have a well-formed scar at the previous subinguinal region incision wound during the clinic visits. None of the 23 patients reported with varicocele recurrence, testicular pain, hydrocele formation or sexual dysfunction. The previous testicular pain or discomfort they encountered prior to the surgery was resolved as well. In conclusion, microscopic subinguinal varicocelectomy using the VITOM telescope is feasible and could achieve good outcomes.

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“…Conventional techniques for varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. Conventional varicocelectomy is complicated by a postoperative recurrence rate of 5–20% in patients with varicocele [5] , [6] , [7] . The use of microscopy has significantly improved the outcome of varicocelectomy [8] .…”

Section: Introductionmentioning

confidence: 99%

Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis

Al-Kandari

Khudair²,

Arafa³

et al. 2018

Arab Journal of Urology

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ObjectiveTo evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation.Patients and methodsIn all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3–12) months.ResultsThe mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%.ConclusionMicroscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the ‘gold standard’ for varicocelectomy.

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

Cited by 3 publications

References 12 publications

Valves of the gonadal veins

Valves of the gonadal veins

Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: outcome analysis

Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis

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