Varicocele anatomy during subinguinal microsurgical varicocelectomy in Chinese men

Abstract

Knowledge of subinguinal microsurgical varicocelectomy is of fundamental importance to ensure that varicocele is resolved and testicular function is preserved. Our study aimed to describe the number of veins, arteries and lymphatics in the subinguinal spermatic cord and to clarify their differences between two sides, between patients with different complaints and between varicoceles with different clinical grades. A total of 102 consecutive patients underwent 162 primary subinguinal microsurgical varicocelectomies, during which the number of vessels with different diameters was recorded. A mean number of 12.9 internal spermatic veins, 0.9 external spermatic veins, 1.8 internal spermatic arteries and 2.9 lymphatics were identified per cord. 88.2% of the internal spermatic arteries were surrounded by a dense complex of adherent veins. The external spermatic vein or veins were found in 49.4% of the cases. The mean number of medium (1-3 mm in diameter) internal spermatic veins on the left was larger than that on the right (P < 0.001). The mean number of medium internal spermatic veins in grade III varicocele was larger than that in grade I or grade II (P < 0.015). There was no significant anatomical difference between the men presenting for infertility, chronic testicular pain and both the two complaints.

Anatomical factors affecting the time required for microsurgical subinguinal varicocelectomy

“…Hopps et al ( 2003 ) reported that 43 % of their MSV cases had multiple ISAs and Libman et al ( 2010 ) reported that 50 % of their MSV cases had multiple ISAs. Similarly, Lv et al ( 2015 ) reported that multiple ISAs were identified in 58 % of patients in their varicocele unit. Most studies have only reported the mean number of ISAs, thus it was unclear whether the number of ISAs is associated with the difficulty of the surgery.…”

“…Although preservation of the ISA is a key step in MSV, however it is not an easy task due to the multiple ISAs and the complex anatomical relationship between the ISAs and adjacent ISVs (Hopps et al 2003 ; Libman et al 2010 ; Lv et al 2015 ). We found multiple ISAs in 39 % of our MSV procedures.…”

Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele

“…Because of the greater number of internal spermatic arteries and because these arteries are surrounded by a dense network of adherent veins, the identification of internal spermatic artery pulsation is difficult in the subinguinal and classical inguinal approaches carried out near the external inguinal ring. 15,18,19 In contrast, the number of internal spermatic arteries around the internal inguinal ring was typically one, and the diameter was significantly larger than those of the arteries found at the subinguinal level ( Table 2). These findings are consistent with previous anatomical descriptions.…”

“…These findings are consistent with previous anatomical descriptions. 15,18,19 The primary branch point of the testicular artery is usually located along its course through the inguinal canal. Furthermore, the need for a Doppler probe to identify the artery was less frequent with the high inguinal approach (Table 2), which involves the creation of a wide opening in the inguinal canal.…”

Comparative Analysis of Methods of Surgical Treatment of Varicocele

“…В данный обзор не вхо-дили мужчины с азооспермией, ранее получавших оперативное лечение по поводу варикоцеле. Также в данный обзор не входили исследования мужчин с субклинической степенью варикоцеле [6,7].…”