Preservation of Testicular Arteries During Subinguinal Microsurgical Varicocelectomy: Clinical Considerations

Grober, Ethan; O’Brien, Jeanne; Jarvi, Keith; Zini, Armand

doi:10.1002/j.1939-4640.2004.tb02849.x

Cited by 39 publications

(25 citation statements)

References 15 publications

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“…46,48 In a number of studies, it has been shown that microsurgical varicocelectomy (inguinal or subinguinal) is superior to non-microsurgical procedures with respect to the development of postoperative complications such as hydrocele or recurrence. 41,46,47 Hydrocele formation is believed to be due to ligation of lymphatic channels and recurrence generally results from incomplete ligation of collateral venous channels. 53,54 Magnification of the spermatic cord with the use of the operating microscope reduces the potential for development of such complications.…”

Section: Discussionmentioning

confidence: 99%

“…53,54 Magnification of the spermatic cord with the use of the operating microscope reduces the potential for development of such complications. 41,46,47 However, microsurgical varicocelectomy, particularly the subinguinal approach, remains a technically challenging procedure that requires microsurgical expertise. This article has been peer reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Varicocelectomy: Approachesmentioning

confidence: 99%

See 1 more Smart Citation

Varicocelectomy: microsurgical subinguinal versus inguinal technique

Zini

Binsaleh²,

Lo³

2012

CUAJ

Self Cite

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“…However, a hydrocele occurred in the open inguinal group, whereas no hydroceles or testicular atrophy occurred in the LESS group after spermatic artery scarifying. In addition, Grober et al 20 suggested that the number of arteries identified and preserved with meticulous spermatic cord dissection during subinguinal varicocelectomy does not correlate with clinical outcomes. Therefore, the effort of lymphatics and testicular artery sparing during LESS varicocele ligation made the difference of clinical outcomes insignificant.…”

Section: Discussionmentioning

confidence: 99%

Umbilical laparoendoscopic single site surgery versus inguinal varicocelectomy for bilateral varicocele: A comparative study

et al. 2011

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Abstract:We aimed to determine the efficacy of umbilical laparoendoscopic single site surgery (LESS) bilateral varicocelectomy on the basis of a comparative study versus open inguinal bilateral varicocelectomy. We enrolled 39 patients who underwent bilateral varicocelectomy with predetermined surgical indications at two hospitals with either the LESS (n = 19) or the open inguinal approach (n = 20). Operative time, operation-related pain (10-point visual analog pain scale), catch-up growth of the testes, semen parameters, and complications after surgery between the LESS group and the open group at 3 months after surgery were compared. Operative times were 46.8 and 72.8 min (P < 0.001) in the LESS and open surgery groups, respectively. Patients in the LESS group reported lower surgery-related pain than those in the open surgery group at 3 months (2.5 vs 1.2, P = 0.029). A significant improvement in terms of semen concentration, motility, catch-up growth of the bilateral testes was observed in both groups, although no significant differences were detected between the groups. Postoperative complications were also similar between the two groups. LESS varicocelectomy required a shorter operative time than inguinal varicocelectomy for bilateral cases. In addition, the LESS procedure showed less postoperative pain and cosmetic benefits with similar seminal outcomes. Thus, LESS for patients undergoing bilateral varicocelectomy represents a promising surgical approach.

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“…2). Testicular artery(ies) was confirmed by the visualization of clear pulsatile movement [10], with the magnification and sometimes the use of papaverine, it is easy to identify the testicular artery Figure 1b showed the same field under operating microscope (89) World J Urol at inguinal level. In the end, all the internal spermatic veins were ligated; the lymphatics, arteries, and vas deferensassociated vessels were preserved.…”

Section: Techniquementioning

confidence: 92%