Thromboses of the pampiniform plexi after subinguinal varicocelectomy

Zampieri, Nicola; Castellani, Roberto; Mantovani, Alberto; Scirè, G.; Peretti, Marta; Zampieri, G; Camoglio, Francesco Saverio

doi:10.1007/s00383-013-3426-1

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…Thrombosed varicoceles have been described as a rare cause of acute scrotal pain [ 2 – 4 ]. Postoperative thrombus in pampiniform plexuses have been managed conservatively with intravenous antibiotics, parenteral and oral analgesics, scrotal elevation with bed rest [ 3 ]. Spontaneously occurring thrombi have also been reported to have been managed medically in a previous case, though the exact details of medical treatment are unclear [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

2018

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BackgroundAcute scrotal pain has various causes. Testicular torsion, torsion of appendages and Epididymo-orchitis are common causes, while varicocele thromboses are a rare cause. Varicocele thromboses can occur post operatively or spontaneously. Five cases of post-operative and five cases of spontaneous thromboses have been described till date. The traditional advice in the management of thrombosed varicocele has been to manage it conservatively in all patients by drugs and scrotal support with little description of the surgical treatment. Herein, we present an unusual sixth case of spontaneous thromboses of varicocele and discuss its presentation and surgical management. We would also like to highlight the differentiating points between spontaneous thrombosis and post operative in vitro clot formation in the varicoceles, as these two entities can often be confused for each other.Case presentationA 68 year-old man presented with excruciating scrotal pain of one week duration. Doppler study of scrotum revealed left varicocele with no evidence of Epididymo-orchitis. He was treated with intravenous antibiotics, analgesics and scrotal elevation. He had no relief and continued to have severe pain. Clinical examination was normal. Patient underwent exploratory surgery on a semi- emergent basis. Exploration revealed normal testis with thrombosed varicoceles. Patient underwent Varicocelectomy. Postoperatively patient had immediate pain relief. Histopathology revealed prominent thrombosed varicocele. A varicocelectomy specimen (done for primary infertility) was used for comparison. The differentiating points between the two entities were noted.ConclusionSpontaneous thrombosis of varicocele is a rare cause of acute scrotal pain. Pain out of proportion to clinical features is characteristic. Patients not responding to medical therapy may need varicocelectomy. Varicocelectomy may give immediate relief. Histopathology is useful in this disorder.

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Section: Discussionmentioning

confidence: 99%

Thrombosed varicocele - a rare cause for acute scrotal pain: a case report

2018

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“…In spite of thrombosis of the pampiniform venous plexus after subinguinal varicocelectomy being already described [4], the etiology of spontaneous spermatic venous thrombosis remains unknown. Different hypotheses have been described including prolonged stress (or sexual activity) [5-7] or Buerger’s disease [5, 8].…”

Section: Discussionmentioning

confidence: 99%

Deep Vein Thrombosis: A Rare Cause of Acute Testicular Pain. Case Report: Literature Review

et al. 2018

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Introduction: Thrombosis is defined as the formation of a clot in a blood vessel that obstructs the flow of blood to the peripheral tissues. The incidence of thromboembolic disease ranges from 0.7 to 1.2% within urology. Case Report: A 40-year-old warehouse worker male presented to the emergency department with worsening of a month’s lasting scrotal pain. Physical examination showed the presence of an enlarged and painful left testicle with no other findings. Right testicle, penis and abdominal examination showed no abnormalities whatsoever. Bilateral varicocele with a partial thrombosis of the left one associated with left inguinal hernia was diagnosed by performing an urgent testicular ultrasound test. Conservative treatment was first given. However, since pain was not relieved, surgery was indicated with left varicocelectomy and a left inguinal hernia repair procedure leading to complete symptoms control and normal testicular flow in the control Doppler ultrasound study 2 months after the surgery. Conclusion: Spontaneous thrombosis of the pampiniform plexus is a rare entity where the management remains controversial. The clinical case we report here shows that surgery may be considered an effective option.

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“…7 Kayes et al reported that spontaneous vein thrombosis could be related to prolonged vigorous sexual activity or sport activity, tumours of the genitourinary tract, infections, trauma, inguinal hernia surgery, long-hour flights, and the use of some drugs. 8 Mirilas et al cautioned for a complex system that should be carefully considered when opting for the subinguinal approach and found it necessary to carry out a comprehensive preoperative hemodynamic assessment of the vein reflux to decide on the most suitable surgical technique.…”

Section: Discussionmentioning

confidence: 99%