Management options of varicoceles

Chan, Peter

doi:10.4103/0970-1591.78431

Cited by 61 publications

(58 citation statements)

References 71 publications

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“…Exclusion of the retroperitoneal, scrotal and laparoscopic options was made given the relative infrequency with which these surgeries were performed and the associated lack of comprehensive costing and outcomes. 21,22 A decision tree was constructed ( cost-effectiveness of varicocele repair consisted of a primary treatment followed by a secondary treatment for recurrences or treatment failures ( Table 1, Fig. 1).…”

Section: Model Designmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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Introduction: Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. Methods: A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Results: Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. Conclusions: MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

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Section: Model Designmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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“…11 On the whole, the treatment for the varicocele is surgical by occlusion of the testicular veins. The previous common approach is the inguinal route, but there is a 40% recurrence rate.…”

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confidence: 99%

Laparoscopic Varicocelectomy: My Personal Experience of 4000 Cases

Chen

2016

International Surgery

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Varicocele accounts for 40% of male infertility. Laparoscopic varicocelectomy was used for the treatment of a series of 4000 men. The operation was a high bilateral ligation. The average time for the operation was 1 hour and 15 minutes. There were no complications and patients were discharged on the same day of the operation. Testicular damage from varicocele was permanent, and the usual percentage was 10% of total testicular tissue examined. The surgery was very well accepted by patients. Semen parameters improved among 80% of the patients, with 45% of their wives becoming pregnant. There is clearly a role for video laparoscopic varicocelectomy in the treatment of male infertility.Key words: Varicocele -Laparoscopic varicocelectomy -Male infertility -Abnormal semen I t is common knowledge that fertility is declining worldwide, with a rate of 25% among couples 1,2 ; of that number, the male contribution is conservatively at approximately 45%.3 While there are multiple causes in the male, one major cause is varicocele, which now cannot be ignored or even brushed off as controversial. In fact, both the American Society for Reproductive Medicine and the American Urological Association have found that varicocele causes infertility. 4 The incidence of varicocele can vary between 19% and 41% (the incidence is more reflective to that of 41%). 5,6 Varicocele has been shown not to begin at adulthood, but more likely at adolescence or 9 As a result of leakage, there is a backflow of renal blood down these veins. This renal reflux results in toxic damage to both spermatogenesis and male hormone production by the Leydig cell. 10Consequently, the testes are damaged in varying progressive stages over time. There is hyperthermia, testicular shrinkage and atrophy, sperm membrane damage, chromosomal breaks, spermatogenic arrest, maturation arrest, Sertoli cell destruction, and germinal epithelial sloughing. Male hormone production also declines, which affects health, and accelerates andropause. In its earlier subclinical stages, varicocele is diagnosed by Doppler ultrasound, whereas in its later more advanced clinical stages, the swollen veins become palpable. The condition is bilateral, but may appear to manifest unilaterally.When medically indicated for clinically significant varicoceles, many treatment options have been used over time.11 On the whole, the treatment for the varicocele is surgical by occlusion of the testicular veins. The previous common approach is the inguinal route, but there is a 40% recurrence rate. 12Scrotal varicocelectomy is not practiced because of its poor smaller vessels and poor results. Thus, a high peritoneal varicocelectomy approach through the abdomen is more effective because there are fewer and larger varicose veins. 13,14 Methods PatientsThis study involved 4000 laparoscopic varicocelectomies for infertility from 1995 15 to 2015. Their ages ranged from 26 and 68 years. The majority were in the age group of 30 to 34 years, with a 3-year history of infertility. These men had semen analysis. Ind...

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“…Varikokela je jedan od najčešćih uzročnika muškog infirtiliteta, mada tačan način na koji ona utiče na spermatogenezu nije poznat (3)(4)(5). Smatra se da je taj uticaj posledica dugotrajnog delovanja više faktora kao što su povišena skrotalna temperatura, hormonalni faktori, hipoksija testisa, refluks toksičnih metabolita iz bubrega i nadbubrežnih žlezda, povećana koncentracija azotmonoksida i slobodnih radikala.…”

Section: Dijagnostika Varikokelaunclassified

“…Klinički manifestno poboljšanje postiže se na levoj strani u preko 95% slučajeva, a na desnoj strani ređe (65%-85% ) (18). Perzistencija varikokele posle embolizacije je retka (do 5% ) (18)(19)(20) za razliku od hirurške ligature (do 45%) (4). emboloterapija se koristi i za otkrivanje i lečenje kolateralnih vena kod varikokela zbog kojih najčešće nastaje recidiv posle hirurške ligature.…”

Section: Slika 1 Izbor Katetera Prilagođen Anatomskim Karakteristikaunclassified

Technical aspects of embolization of internal spermatic vein in varicocele treatment

Pantelić¹,

Pervulov²

2012

Medicinski casopis

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UVODVarikokela nastaje zbog poremećaja venske cirkulacije u testisu i epididimu u vidu dilatacije i varikoziteta vena pampiniformnog pleksusa. najčešće je posledica slabosti zalistaka unutrašnje spermatične vene, što dovodi do usporene cirkulacije i refluksa u pampiniformni pleksus. To uzrokuje povećanje intravenskog pritiska, a zbog toga i dilataciju unutrašnje spermatične vene i vena pampiniformnog spleta. U uslovima usporene cirkulacije dolazi do povišenja temperature testisa, a usporena cirkulacija uz povišenje temperature testisa favorizuje pojavu infekcija. Ugroženi su mladi muškarci starosti od 15-25 godina. Hemodinamski poremećaj može da ugrozi spermatogenezu i dovede do smanjenja fertiliteta. mogućna su i ireverzibilna oštećenja germinativnog epitela testisa koja mogu da dovedu do trajnog infirtiliteta. ETIOPATOGENEZA VARIKOKELAPostoje mnogobrojni faktori koji su od značaja u nastanku varikokele: nedostatak, nerazvijenost ili inkontinencija venskih zalistaka unutrašnje spermatične vene, nepovoljan ugao uliva, uklještenje završnog dela leve bubrežne vene između aorte i gornje mezenterične arterije, fibrozno-sklerotične promene mišićno-fascijalnog omotača semene vrpce, konstitucija i kongenitalni faktori.Varikokela je u većini slučajeva unilateralna, levostrana. Gat i saradnici varikokelu posmatraju kao bilateralno vaskularno oboljenje i u slučajevima kada se sumnja na unilateralnu varikokelu (1). Prevalencija levostrane varikokele je posledica činjenice da se leva unutrašnja spermatična vena drenira u levu renalnu venu pod pravim uglom. Pored toga od značaja je mogućnost da proširenje leve spermatične vene nastane zbog postojanja anatomske ,,prepreke" koju formira abdominalna aorta sa svojim visceralnim granama (2). DIJAGNOSTIKA VARIKOKELAVarikokela je jedan od najčešćih uzročnika muškog infirtiliteta, mada tačan način na koji ona utiče na spermatogenezu nije poznat (3-5). Smatra se da je taj uticaj posledica dugotrajnog delovanja više faktora kao što su povišena skrotalna temperatura, hormonalni faktori, hipoksija testisa, refluks toksičnih metabolita iz bubrega i nadbubrežnih žlezda, povećana koncentracija azotmonoksida i slobodnih radikala. nijedna od ovih teorija nije definitivno dokazana. Kod velikog broja bolesnika varikokele su asimptomatske i otkrivaju se pregledom kada se pacijent obrati lekaru zbog infertiliteta (6). Postoje dve vrste asimptomatskih varikokela: ,,kliničke", koje se

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Management options of varicoceles

Cited by 61 publications

References 71 publications

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Laparoscopic Varicocelectomy: My Personal Experience of 4000 Cases

Technical aspects of embolization of internal spermatic vein in varicocele treatment

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