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PubMed1990

[Male varicocele. Analysis of the incidence of varicocele in a population of 18,800 young men].

The authors evaluate the incidence of varicocele after having examined 18,800 healthy white men members of the Italian Army Corps born in 1966 and visited in 1985. They found a varicocele in 775 patients (4.12%), in 5 was present bilaterally, and in 770 in the left side. In 45 patients the surgical treatment was already done at the time of the examination and there were 3 recurrences. The patients with varicocele were divided according to the classification of Dubin-Amelar and were: grade I n. 175 (0.93%); grade II n. 515 (2.74%); grade III n. 35 (50.18%). In 566 (73.03%) the diagnosis was done at the moment of the examination, 152 (19.62%) discovered the varicocele at the self examination; in 57 (7.37%) the diagnosis was already done by the family doctor. Infertility is sometime associated to the varicocele and with the unrelieved local discomfort are the main indications for surgery. It should be also emphasized the need of education on the infertility problems during the high school that is a time of the life in which there is the highest incidence of varicocele.

Adult↗
PubMed1987

[Diagnosis of varicocele with bidirectional Doppler sonography. A contribution to the pathogenesis of varicocele].

A total of 375 patients with varicocele were examined by bidirectional Doppler sonography. Venous reflux was classified as one of two Doppler grades: spontaneous reflux and Valsalva-induced reflux. The Doppler grades were compared with clinical aspects (e.g. size) of the varicocele. Using bidirectional recording, it is possible to describe two hemodynamically different types of varicoceles (the pressure type and the shunt type). On the basis of the Doppler results the pathogenesis of varicocele can be determined. Spontaneous reflux causes the shunt type and the medium-sized and large varicocele, while Valsalva-induced reflux causes the pressure type or the stop type and the small and subclinical varicocele.

Blood Flow Velocity↗
PubMed2005

Is it worthwhile to operate on subclinical right varicocele in patients with grade II-III varicocele in the left testicle?

PURPOSE: To determine whether repair of subclinical varicoceles in the right testicle results in significant seminal improvement in patients with clinical left varicocele. METHODS: Patients were divided into two groups: Group I (unilateral varicocelectomy) and Group II (bilateral varicocelectomy-subclinical left varicocele). The mean sperm concentration before treatment was higher in Group I (21.01 +/- 19.1) compared to Group II (5.7 +/- 10.7) (p = 0.04). RESULTS: An increase in volume was detected in the left testicle of patients in Group I (17 +/- 7.9 vs. 22.81 +/- 8.2; p = 0.04) and in the right testicle of patients in Group II (18.4 +/- 6.2 vs. 22.3 +/- 6.5; p = 0.04). Although the mean postoperative sperm concentration in Group I increased slightly (25.7 +/- 22.8), the mean sperm concentration in Group II increased significantly (30.32 +/- 9.8; p = 0.03). Pregnancy rate was higher in Group II (66.7%) compared to Group I (33.3%). CONCLUSIONS: Even a small, subclinical unrepaired varicocele continues to have a detrimental effect on bilateral testis function in a patient with grade II-III left varicocele.

Adult↗
PubMed2004

Increased seminal reactive oxygen species levels in patients with varicoceles correlate with varicocele grade but not with testis size.

Increased levels of reactive oxygen species (ROS) are associated with clinical varicoceles; however, its correlation with varicocele grade and testis size is unknown. In our study, seminal ROS levels showed significant correlation with left varicocele grade and significantly elevated seminal ROS levels were seen in men with left varicocele grade 2 and 3 compared to grade 1.

Adult↗
PubMed1986

Hemodynamics of the varicocele. Part II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography.

Left renal vein compression occurring mainly with the patient in the upright position, and being less severe or absent in the supine position, was considered to be the main cause of varicoceles. We show that left renal vein compression is, indeed, more severe with the patient in the upright than in the supine position and that it produces a left renocaval pressure gradient that is responsible for the retrograde blood flow in the left testicular vein. This pressure gradient, which was determined in the supine and semierect positions in 34 patients, increased from a mean of 3.8 mm. Hg in the supine position to a mean of 7.8 mm. Hg in the semierect position. On the basis of the assumption that the renocaval pressure gradient measured with the patient in the semierect position determines the presence and velocity of a retrograde flow in the left testicular vein, as shown by the dynamic portion of the varicocele scintigram (see part I), these variables were analyzed and the correlation coefficient proved to be good. Therefore, we conclude that the varicocele occurs when the left testicular vein lacks valves or there is a renogonadal bypass, and the severity of the left renal vein compression in the (semi) upright position determines the velocity of the retrograde flow in the left testicular vein and the size of the varicocele.

Blood Pressure↗
PubMed1992

Surgical repair versus medical treatment of varicocele in the rat: pharmacological manipulation of the varicocelized testicle.

Human chorionic gonadotropin, kallikrein, indomethacin, and hydralazine were administered to different groups of varicocelized rats, while surgical repair of the varicocele was performed in another group of rats. The effects of conservative and surgical treatment on epididymal sperm content and motility, the weights of the testes, epididymis, and male accessory genital glands, and fertility were compared between each group and a sham-treated group of rats. Surgical repair significantly improved all the evaluated parameters and all the conservative regimens, except hydralazine, resulted in a significant improvement in most parameters. Our results indicate that stimulation of the Leydig or/and Sertoli cells of a varicocelized testicle can counteract some of the detrimental consequences of the varicocele itself.

Animals↗
PubMed1989

Hemodynamics of varicoceles: venous shunting in grade II and III varicoceles.

In 42 consecutive patients with moderate (grade II) or large (grade III) left-sided idiopathic varicoceles, which were referred for percutaneous sclerotherapy, not only the reflux in the testicular vein but the venous drainage as well was studied by venography. As suggested by bidirectional Doppler sonography the reflux in the testicular vein is always associated with an upward (in physiologic direction) flow in these varicoceles. The draining veins are shown to be the deferential, cremasteric, external pudendal, or any combination of these. Thus, the grade II and III varicoceles are termed shunt-type varicoceles.

Collateral Circulation↗
PubMedDate not supplied

Induction of varicocele in the dog: I. Partial ligation of the left renal vein does not induce a varicocele in the dog.

Induction of varicocele was attempted by partial ligation of the left renal vein in 10 male dogs. The effects on sperm count, sperm motility, and sperm morphology, as well as on hemodynamics, were assessed. Furthermore, testicular, vascular, and kidney morphology was studied. Changes in the diameter and consistency of the left spermatic cord were found to be temporary. Total sperm count, sperm motility, and the total number of oval forms were not significantly altered. Hemodynamic studies revealed a renocaval pressure gradient, but retrograde flow in the distal part of the left testicular vein could not be observed by arteriography. A collateral network was found to compensate for the restricted left renal vein. Histologic examination revealed no damage to the seminiferous epithelium. Changes were not found in the kidney and left pampiniform plexus. Although some temporary changes induced by the partial ligation of the left renal vein are suggestive of varicocele, this hemodynamic study shows that the presented dog model does not mimic varicocele as encountered in man.

Animals↗
PubMed2005

Benefits of microsurgical repair of adolescent varicocele: comparison of semen parameters in fertile and infertile adults with varicocele.

OBJECTIVES: To compare preoperative semen parameters and the effect of microscopic varicocele repair on semen parameters in adolescents, fertile adults, and infertile adults with varicocele. METHODS: A total of 96 patients (35 adolescents, 20 fertile adults, and 41 infertile adults) were included in the primary analysis. RESULTS: The fertile adults had a higher sperm count than did the adolescents or infertile adults (P <0.001). In infertile adults, the percentage of normal sperm increased from 14.9% +/- 1.0% preoperatively to 21.2% +/- 2.2% at 3 months (P = 0.013) and 22.1% +/- 2.2% (P = 0.003) at 6 months. The infertile adults had a lower sperm count than did the adolescents and fertile adults at both 3 (P = 0.014) and 6 (P = 0.003) months. The postoperative sperm motility in adolescents was significantly greater than that in the infertile adults at 3 (P = 0.009) and 6 (P = 0.003) months. The proportion of sperm with normal morphology was not statistically different at either 3 or 6 months among the groups. No significant differences were detected in the increase in semen parameters at 3 or 6 months among patients before or after surgery. CONCLUSIONS: The results of our findings suggest that after varicocele repair the degree of improvement in semen parameters is not different. However, because the baseline values of the semen parameters in adolescents were better than those in infertile adults, the postoperative values in the adolescents were superior to those in infertile adults and at least as good as those in fertile adults.

Adolescent↗
PubMed2001

The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long-term follow-up.

OBJECTIVE: To determine, in adolescent boys after varicocelectomy, the incidence of hydroceles, when they develop and whether the development is procedure-related. PATIENTS AND METHODS: The records were retrospectively reviewed of 77 boys who underwent 95 varicocelectomies and had an examination at > or = 6 months after surgery. Fifty-six patients underwent a standard Palomo procedure (45 left and 11 bilateral) and 21 a modified Ivanissevich repair (14 left and seven bilateral). The mean (range) age of the patients at surgery was 14.1 (10-22) years and the mean follow-up 25.5 (6-84) months. RESULTS: Of the 67 Palomo varicocelectomies 19 (24%) were complicated by hydroceles after surgery, compared with four of 28 (14%) Ivanissevich procedures (P = 0.034). Of the Ivanissevich repairs, none of the 14 unilateral repairs developed hydroceles. Three hydroceles (one bilateral and one left) developed in two of seven patients after bilateral varicocelectomy. Of the Palomo repairs, 12 of 45 unilateral repairs were complicated by hydroceles, and seven developed in five of 11 patients after bilateral varicocelectomy. Although more hydroceles developed after bilateral varicocelectomy, there was no significant difference from the unilateral group. However, patients who developed hydroceles after bilateral varicocelectomy were more likely to require hydrocelectomy (P = 0.013, Fisher's exact test), implying that hydroceles developing after bilateral repair tend to be larger. Of the hydroceles, two were detected in the first 6 months after surgery, nine at 6-12 months, three at 13-18 months, five at 19-24 months and four at > 2 years after surgery. Three patients had late varicocele recurrence, i.e. 15, 37 and 76 months after surgery; these patients had not had varicoceles on palpation after surgery at 3, 14 and 63 months, respectively. CONCLUSION: Hydroceles are detected infrequently within 6 months of varicocelectomy, with most occurring after 6 months and even appearing after 3 years. They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic-sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months after varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.

Adolescent↗
PubMed1986

[Non-invasive imaging procedures in the diagnosis and control of therapy of varicoceles. 2. Importance of thermography and sonography for therapy control following sclerotherapy of varicoceles].

In 41 patients with varicoceles, a combined thermographic and sonographic examination of the scrotum was carried out pretherapeutically as well as 14 days and 3 months after percutaneous sclerotherapy. In the differentiation of a successful sclerosing or a varicocele persistence, thermography shows a higher sensitivity than sonography with 34 posttherapeutic normal findings and 7 persisting hyperthermias. The sonographic sign of a successful varicosclerosation is the absence of venous dilation of the pampiniform plexus in an upright position with Valsalva's manoeuvre in 36 patients. After proximal sclerosing of the testicular vein sonography reveals a reduction in vascular size; thrombosed veins of the pampiniform plexus are demonstrated only after distal sclerosing. There are no sonographically detectable disorders of the testes after varicosclerosation. Thermographic and sonographic control after percutaneous sclerotherapy or surgical ligation of varicoceles is indicated in children and in doubtful clinical or spermatological cases.

Adolescent↗
PubMedDate not supplied

Varicocele ligation on free testosterone levels in infertile men with varicocele.

We have analyzed the effects of varicocele ligation on free testosterone levels, and investigated the interrelationships between free testosterone and fertility. The records were retrospectively evaluated for 42 infertile patients who underwent varicocele ligation, with serum free testosterone levels, follicle stimulating hormone (FSH), lutenizing hormone (LH), testosterone, estradiol, prolactin, ejaculated volume, sperm concentration and motility before and after surgery. Serum free testosterone levels increased from 12.97+/-4.16 to 13.59+/-3.93 pg/mL, but the difference was insignificant. The differences before and after surgery of patients in sperm concentration and motility were also insignificant. However, in free testosterone increasing group, the sperm concentration and motility increased significantly, from 4.05+/-4.35 to 7.90+/-8.19 million/mL (P=0.01) and from 30.64+/-21.87% to 41.00+/-22.00%, respectively (P=0.03). The increase in serum free testosterone level by varicocele ligation results in a significant improvement in sperm concentration and motility.

Adult↗
PubMedDate not supplied

[Varicocele at a prepubertal age. Adolescent varicocele].

Varicocele is a dilatation of the spermatic veins, particularly on the left side, and represents one of the most frequent causes of male infertility. Its frequency in pre-adolescence varies from 10% to 15%. Even today varicocele pathogenesis is not clear. In the period from August 1990 to August 1999, 35 males between 10 and 16 years of age were treated surgically in our Institution via interruption of the internal spermatic vein using Palomo's technique. Patients that reached the age of 18 after surgery have had a spermiogramm. The problem of varicocele therapy in pre-adolescence has not yet been resolved with regard to surgical therapy and follow-up.

Adolescent↗
PubMed1988

[Clinical studies of varicocele. 1: Clinical statistical analysis of varicocele].

A clinical statistical analysis was conducted of the patients with varicocele who visited the Department of Urology, Osaka City University, and its related hospitals. Regarding the age distribution, patients younger than 50 years old were predominant; this age group included 20 of 24 cases, or 83%. An overwhelming majority of the cases, 75%, had the main complaint of infertility; they had not been able to have children even after 2 to 3 years of marriage. The next most common complaint was swelling and/or an uncomfortable feeling of the contents of the scrotum. In all of the cases, the lesion was seen in the left side of the scrotum. When the patients were classified on the basis of the sperm count, oligospermia was predominant; it was seen in 15 cases (62.5%). A study on the relationship between the sperm count and the grade of varicocele revealed a tendency for the sperm count to show an inverse relationship with the grade. Testicular atrophy showed a direct correlation with the grade. Of the patients with varicocele, 5 patients had one or more children, while 8 patients (61.5%) complained of their inability to have a child. No particular relationship could be identified between the age at the time of visiting our Department as outpatients and the degree of testicular atrophy.

Adolescent↗
PubMedDate not supplied

Left adrenalectomy in varicocelized rats does not inhibit the development of varicocele-related physiologic alterations.

OBJECTIVE: To evaluate the importance of retrograde adrenal metabolite flow for testicular function in a varicocelized animal model. MATERIALS AND METHODS: Partial occlusion of the left renal vein and ligation of the collateral vein between the left testicular and left common iliac veins was carried out on 14 Wistar rats (group A); same procedure plus adrenalectomy on 14 others (group B); seven sham operated (C) and seven with adrenalectomy alone (D). RESULTS: Groups A and B showed significant reduction in fertility, and also bilaterally in difference between testicular and abdominal temperatures, epididymal spermatozoal content and motility, and testicular weight at 12 weeks post-surgery. All values were nearly identical in groups A and B. CONCLUSIONS: Since left adrenalectomy did not ameliorate the effects of varicocele, it appears that retrograde flow of adrenal metabolite(s) may not be responsible for the harmful effect of (left) varicocele on fertility.

Adrenal Glands↗
PubMed1984

Haemodynamic aspects of left-sided varicocele and its association with so-called right-sided varicocele.

A method has been developed which uses a radionucleotide to demonstrate retrograde bloodflow in the testicular vein and the size of the pampiniform plexus in patients with a varicocele. This method and phlebography were both performed in 71 patients. The radionucleotide method was reliable in showing retrograde flow in the testicular vein and enabled quantification of the size of the pampiniform plexus. On the right side, however, retrograde bloodflow or an enlarged pampiniform plexus were not found in any of the 71 patients. Misinterpretation of phlebographic and radionucleotide studies are probably responsible for recent reports on the frequent occurrence of right sided varicocele.

Humans↗
PubMed1988

[Clinical studies of varicocele. 2: Radiographic examination and measurement of spermatic vein pressure in varicocele patients].

There are two types of internal spermatic veins (ISV) by radiographic examinations. In type 1, ISV is dilated with some collateral venous branches. On the other hand, ISV of type 2 is narrowed with increased collateral venous branches or abnormalities such as the circumaortic renal are seen. In these groups, pressure of renal vein and ISV were measured. As a result, renal vein pressure was about the same in type 1 as in the controls at 9.5 +/- 2.3 cmH2O but was higher in type 2 at 17.0 +/- 2.8 cmH2O. As for ISV, it was also about the same in type 2 as in the controls at 13.9 +/- 6.8 cmH2O but was markedly higher in type 2 at 33.3 +/- 3.9 cmH2O. When selective renal venography was performed, a contrast medium back-flow was seen in 9 out of 11 type 1 varicocele patients, but it was not seen in any of the cases with the nutcracker phenomenon. These results suggested that type 1 may be caused by the structural and functional disorders in the valve between the renal vein and ISV. In contrast, pathogenesis of type 2 varicocele may be due to an abnormality of the ISV in the embryo.

Humans↗
PubMed1979

[Improvement of male fertility through ligation of varicocele? A study of 100 subfertile varicocele patients three months after ligation (author's transl)].

With 100 subfertile varicocele patients, three months after ligation (high ligation of the left internal spermatic vein in accordance with Bernardi) had control spermiograms made. An improvement of sperm count (upgrade in a higher class according to MacLeod's partition) was found in 28% of the cases, whereas an improvement of progressive motility was found only in 13%. The percentage of patients reaching the normal value in sperm count of over 40 mill./ml increased from 23% to 39%. The increase in these patients came primarily from the class of 20--40 mill./ml. In progressive motility, there was an increase of patients reaching the standard value of over 40%, from 6 to 11. However, if sperm count and progressive motility together were evaluated in the individual patients after ligation, only 6 patients presented a normospermia, i.e. a sperm count of more than 40 mill./ml with normal progressive motility. Thus 94 of the 100 patients must be considered as subfertile three months after ligation. A significant fertility improvement through ligation of varicocele has not yet taken place.

Adult↗