Varicocele is the main cause of male infertility. Treatment stops continuous damage to spermatogenesis, thereby potentially improving fertility. Among all the available procedures, the antegrade scrotal sclerotherapy (ASS), a combined radiological-surgical approach first introduced by Tauber, is gaining more popularity due to its minimal invasiveness. We report the case of a 35-year old man who was subjected to a colonic resection after antegrade scrotal sclerotherapy for varicocele. The procedure was necessary due to the embolization of venous anastomosis between the spermatic and mesenteric veins, which were not detectable at the preoperative phlebography.
IntroductionVaricocele represents the main cause of male infertility and leads to changes in testicular spermatogenesis in 60% to 70% of cases. Treatment prevents continuous damage to spermatogenesis, thereby potentially improving fertility. Successful treatment of varicocele improves semen quality in 40% to 60% of patients and recovers fertility in 10% to 40%.1 Among all the available procedures, the antegrade scrotal sclerotherapy (ASS) is a combined radiological-surgical approach first introduced by Tauber in 1988 2 and is usually performed under local anesthesia. The procedure starts with a short longitudinal scrotal incision at the base of the scrotum, isolation of the funiculum and identification of the most enlarged vein. Thereafter, a small incision of the vein allows for the insertion of a 23-gauge needle to perform a venogram by iodine contrast. In the end atoxysclerol mixed with air is injected. [2][3][4][5] This technique is well-established to treat varicocele. It is easier, faster and less invasive than open surgical and laparoscopic treatments.5 It results in a persistence rate as high as 9% in adults and 3% in children. 6 An analysis of seminal parameters showed a statistically significant improvement in the rate of fast progressive spermatozoa and reduction of immotile spermatozoa in patients who underwent ASS compared to open surgery. 5 Reported complication rates are low and they include scrotal hematoma, sterile epididymitis (due to paravascular application of the sclerosing agent), testicular atrophy (accidental sclerotherapy of the testicular artery), as well as intestinal 7 and abdominal wall necrosis (accidental sclerotherapy of the cremasteric artery).
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Case reportA 35-year-old man presented with severe oligoasthenospermia and diagnosed with third grade varicocele on ultrasound. After we explained the therapeutic options to the patient, he agreed to undergo antegrade scrotal sclerotherapy. Incising the base of the scrotum, the funiculum was identified and the most enlarged vein was isolated and suspended between two slack sutures. A little incision of the vein was performed to insert a 23-gauge needle. The right position of the needle was checked by washing the vessel lumen with saline solution; the iodine contrast was then injected to perform a venogram (Fig. 1). Finally, during the Valsalva manoeuvre, 1 mL of air was injec...
We present the use of a modified corporoplasty, based on geometrical principles, to determine the exact site for the incision in the tunica or plaque and the exact amount of albuginea for overlaying to correct with extreme precision the different types of congenital or acquired penile curvature due to Peyronie's disease. To describe our experience with a new surgical procedure for the enhancement of penile curvature avoiding any overcorrection or undercorrection. Between March 2004 and April 2013, a total of 74 patients underwent the geometrical modified corporoplasty. All patients had congenital curvature until 90° or acquired stable penile curvature 'less' than 60°, that made sexual intercourse very difficult or impossible, normal erectile function, absence of hourglass or hinge effect. Preoperative testing included a physical examination, 3 photographs (frontal, dorsal and lateral) of penis during erection, a 10 mcg PGE1-induced erection and Doppler ultrasound, administration of the International Index of Erectile Function (IIEF-15) questionnaire. A follow-up with postoperative evaluation at 12 weeks, 12 and 24 months, included the same preoperative testing. Satisfaction rates were better assessed with the use of validated questionnaire such as the International Erectile Dysfunction Inventory of the Treatment Satisfaction (EDITS). Statistical analysis with Student's t-test was performed using commercially available, personal computer software. A total of 25 patients had congenital penile curvature with a mean deviation of 46.8° (range 40-90), another 49 patients had Peyronie's disease with a mean deviation of 58.4 (range 45-60). No major complications were reported. Postoperative correction of the curvature was achieved in all patients (100%). Neither undercorrection nor overcorrection were recorded. No significant relapse (curvature>15°) occurred in our patients. Shortening of the penis was reported by 74% but did not influence the high overall satisfaction of 92% (patients completely satisfied with their sexual life). The erectile function was analyzed in both groups, Student's t-test showed a significant improvement in erectile function, preoperative average IIEF-15 scores were 17.43±4.67, whereas postoperatively it was 22.57±4.83 (P=0.001). This geometrical modified Nesbit corporoplasty is a valid therapy which allows penile straightening. The geometric principles make the technique reproducible in multicentre studies.
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